Antibiotics and Breast-Feeding

Abstract

Continuous breast-feeding, an integral component of the postpartum period, is often threatened upon maternal initiation of antibiotics. The real risk of antibiotic use while breast-feeding must be carefully analysed with regard to all the variables that influence the extent of antibiotic distribution into breast milk, including breast milk composition, physicochemical properties of the antibiotic (molecular weight, lipid solubility, pH, protein binding), length of feeding, and maternal disposition. In addition, infant disposition, including ability to absorb, metabolize, eliminate, and tolerate any amounts of antibiotic, must also be considered prior to maternal administration of antibiotic. The milk to plasma (M/P) ratio is a frequently quoted parameter used to predict drug distribution into breast milk. However, its utility is questionable and often fraught with misinterpretation. An alternative approach when the amount of antibiotic concentration in breast milk is known (through clinical trials) is to calculate an estimated or expected infant drug exposure factoring in known/expected milk consumption, drug concentration and bioavailability. In this review, the following antibiotic classes and current literature regarding their distribution into breast milk are critically reviewed: beta-lactam antibiotics, fluoroquinolones, sulfonamides, macrolides, aminoglycosides, tetracyclines, nitrofurantoin, metronidazole, vancomycin, clindamycin and chloramphenicol. In the majority of instances, these antibiotics do not distribute into breast milk in sufficient concentrations to be of any clinical consequence in the breast-feeding infant.

Interaction of enrofloxacin with breast cancer resistance protein (BCRP/ABCG2): influence of flavonoids and role in milk secretion in sheep

“…Following intravenous administration, ENRO data in different ruminant species were explained by a two-compartmental model (Mengozzi et al, 1996;Bregante et al, 1999;Haritova et al, 2003;Sooud, 2003). ENRO as well as other fluoroquinolones including ciprofloxacin penetrated rapidly and extensively from blood into milk (Aramayona et al, 1996;Chung et al, 2002). Although most drugs enter milk by passive diffusion, some drugs are actively transported into milk.…”

“…ENRO as well as other fluoroquinolones including ciprofloxacin penetrated rapidly and extensively from blood into milk (Aramayona et al. , 1996; Chung et al. , 2002).…”

Comparative Genomic and Metabolomic Analyses of Two Pseudomonas aeruginosa Strains With Different Antifungal Activities

“…The compound 2-hydroxy-4-methoxyacetophenone-5-sulfate is the sulfated conjugate of paeonol (2-hydroxy-4-methoxyacetophenone), which has been reported to show a wide range of bioactivities, including anti-inflammation, antioxidation and antibacterial activities (Chou, 2003). Furthermore, demeclocycline-HCl and sulfamethoxypyridazine are also antibiotics that are widely reported to be effective against various microorganisms (Mendoza et al, 1971;Chung et al, 2002). It should be noted that terconazole, the concentration of which in Y12 was 42-fold greater than that in Y18, has been reported to be an antifungal compound with broad-spectrum biocontrol activity (Weisberg, 1989).…”

GPs' decision-making when prescribing medicines for breastfeeding women: Content analysis of a survey

“…Although this more involved process might help GPs arrive at the most appropriate solutions, in certain instances it did not. GPs reported advising mothers to stop breastfeeding when taking sertraline, metronidazole, and other medicines, although generally these are considered safe for breastfeeding women [34,35]. …”