Antibiotics in breastfeeding: particular application

Many women during breastfeeding experience the need to treat diseases caused by bacteria or pathogenic microbes. Such diseases include pneumonia, pyelonephritis, mastitis, endometritis, infectious inflammation of the urinary tract, etc. For example, acute cystitis, which often occurs after childbirth, is caused by a gram-negative bacterium Escherichia coli or saprophyte staphylococcus, which can overcome only an antibiotic. So there are many situations in which it is necessary to use antibiotics for breastfeeding. The whole question is, which ones.

The safety of the use of antibacterial drugs by nursing women is directly related to the degree of penetration of the active substances of the drug into breast milk and the nature of their possible negative effects when ingested. After taking antibiotics with breastfeeding, not only increases the risk of side effects on the mother's body, but can cause various toxic reactions, as well as biochemical and physiological abnormalities in the child's body.

[1], [2], [3], [4], [5], [6]

Treatment with antibiotics for breastfeeding

In the instructions of the majority of antibiotics, there are three types of formulations concerning antibiotic treatment in breastfeeding (and pregnancy). The first: "Contraindicated during breastfeeding". The second: "The use of the drug during pregnancy and during lactation is possible only if the expected benefit of therapy for the mother exceeds the potential risk of teratogenicity." Third: "There is no information on the probable teratogenic or mutagenic effect of the drug when taken during pregnancy. The drug is able to penetrate into the mother's milk, during the treatment should stop breastfeeding. "

In pharmacology, there are several degrees of study of drug safety. The first degree, when "the study of reproduction on animals did not reveal the risk of adverse effects on the fetus, and adequate and strictly controlled studies in pregnant women are not carried out." The second, in which "the study of reproduction on animals has revealed an adverse effect on the fetus, and adequate and strictly controlled studies in pregnant women have not been carried out, but the potential benefits associated with use in pregnant and lactating women can justify its use, despite the possible risk" .

And with the third degree "there is evidence of the risk of adverse effects of the drug on the human fetus, obtained during research or in practice, but the potential benefits associated with its use in pregnant and lactating women can justify its use, despite the possible risk."

It should be noted that antibiotic treatment during breastfeeding has serious negative consequences, including lesions of the digestive tract (dysbacteriosis), impaired renal and hepatic function, hematopoietic and nervous system, immunosuppression, etc.

Reception of antibiotics during breastfeeding

Reception of antibiotics in breastfeeding, as a rule, involves the cessation of breastfeeding during the course of treatment. As practice shows, often the consequence of a temporary refusal to breastfeed is a violation of the natural lactation process. And then the baby has to be transferred to artificial feeding with special milk formulas ...

To drugs, which in no case can not be treated with antibiotics for breastfeeding, include tetracycline, levomycetin, lincomycin, ciprofloxacin, clindamycin and metronidazole. Thus, tetracycline and its generics can cause children to have bone formation disorders, which affects the growth of tubular skeletal bones and the formation of teeth rudiments. Levomycetin inhibits the hematopoietic function of the bone marrow of infants and can lead to cyanosis (cyanosis of the skin and mucous membranes due to the high content of reduced hemoglobin in the blood) and a decrease in blood pressure. And the use of clindamycin or metronidazole is fraught with a violation of protein metabolism (amyloidosis).

Also absolutely contraindicated in the period of breastfeeding all the antibiotics of the fluoroquinolones group, widely used for the treatment of urological infections, in particular, cystitis of bacterial origin. However, in the US, ofloxacin, a drug of the second generation fluoroquinolone group, has entered safe antibiotics for breastfeeding. And British doctors adhere to the diametrically opposite opinion and believe that all the antibiotics of the group of fluoroquinolones (ofoloxacin, cyprolone, digitalox, digit, levofloxacin, avelox, nolycin, etc.) are not suitable for women who are breastfeeding. Fluoroquinolones damage the interarticulate cartilage and negatively affect the growth of infants. With a single intake of 200 mg of ofloxacin by lactating women, its concentration in breast milk is equal to the content of its blood in the plasma.

Antibiotics compatible with breastfeeding

Antibiotics approved for breastfeeding include antibacterial drugs of such groups as penicillins, cephalosporins and macrolides. More precisely, the use of these drugs in the therapy of nursing women "is usually not contraindicated" ... Penicillins (penicillin, ampicillin, ampiox, amoxicillin, amoxiclav) and cephalosporins (cefazolin, cephalexin, cefaxitin) are thought to fall into small amounts in breast milk , and, therefore, are safe for the health of babies.

According to the research of the American Academy of Pediatrics, amoxicillin can be used during breastfeeding: a single dose of 1 g taken by a nursing mother enters the milk in an insignificant amount (less than 0.095% of the maternal dose), which does not lead to unfavorable consequences for the child. However, sometimes there may be a rash and there is a disturbance of the intestinal microflora. Adverse reactions (rash on the skin, diarrhea, thrush) were noted in 8.3% of children exposed to amoxicillin.

Officially antibiotics of cephalosporins do not cause consequences for infants. But these drugs are seen for dysbiosis and thereby reduce the production of vitamin K in the intestine. And this, in turn, creates a deficit of the coagulating factor of prothrombin in the blood (increased risk of bleeding), and also reduces the level of calcium and vitamin D absorption, which occurs only with participation of vitamin K.

To antibiotics, compatible with breastfeeding, it is customary to include macrolides: erythromycin, azithromycin, sumamed, wilprofen, etc. Although the instructions to the same sumamed are written in black and white: "During pregnancy and lactation, sumamed is not prescribed, except in those cases , when the benefit of using the drug exceeds the possible risk. " According to British pharmacists, antibiotic treatment with breastfeeding is allowed only with erythromycin, and all other drugs from the macrolide group should not be used during pregnancy and lactation. So, as you can see, there is no unanimity among specialists, and the maximum allowance should be used to receive "approved" antibiotics.

Separately it is necessary to say about the group of antibiotics-aminoglycosides (neomycin, kanamycin, gentamicin, amikacin, etc.). Aminoglycosides are more toxic than all other antibiotics. They are prescribed only in the most severe cases - with meningitis, sepsis, peritonitis, abscesses of internal organs. And their side effects are even scary to enumerate, it is enough to name only a decrease in hearing (down to total deafness), defeat of the optic nerve and irreversible vestibular disorders.

Doctors who prescribe antibiotics for breastfeeding are obliged to warn their patients about the possibility of an allergic reaction in the child and other quite likely negative consequences of antibiotic therapy. And in this case it is recommended to stop taking the medication, or temporarily stop breastfeeding.

[7], [8], [9], [10], [11], [12], [13], [14], [15], [16]

Breastfeeding after antibiotics

If a nursing mother needs antibiotic therapy and the doctor has prescribed an antibiotic, then breastfeeding after antibiotics is carried out in the prescribed manner, but the drug intake is adjusted with the time of feeding. According to experts, taking the prescribed medicine is best before the longest break in feeding - that is, in the evening, before going to bed. However, specific recommendations (according to the scheme and duration of administration, daily and single dosage of the drug) should be given by a doctor.

Breastfeeding after antibiotics that are contraindicated or not recommended for lactation should be resumed only after the drug and all its metabolites (products of biological transformation) are removed from the tissues and organs of the nursing woman. At each medication, including antibiotic, this time interval is different. It is indicated in the instructions of the specific medicinal product (in the section "Pharmacokinetics").

The less the drug binds to blood plasma proteins, the more it will be eliminated (removed). There are antibiotics that are excreted from the body in 40-60 hours, and there are those that stay in the body for 5-7 days after taking the last dose.

The prescription of medicinal preparations is the competence of the attending physician. And this is an axiom. However, antibiotics in breastfeeding and in the XXI century are controversial issues of clinical practice. Therefore, in order to avoid the sometimes irreversible consequences, one should be treated with particular caution in taking this group of drugs.

[17], [18], [19], [20], [21]