Antibiotics for lactation

During breastfeeding, women are no less likely to get sick than before or during pregnancy. And at this time, the mother needs to think not only about whether a particular antimicrobial drug is right for her, but also about how it will affect the well-being and health of the baby. Most of the medications that a nursing woman takes quickly end up in breast milk. What to do? In this article, we will tell you how to take antibiotics during lactation if there is a need to take them.

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Is it possible to take antibiotics during lactation?

Before prescribing an antibiotic to a nursing mother, the doctor should answer the following questions:

• Will the drug harm the baby?
• Will taking antibiotics affect milk production?
• Is it possible to do without antibiotic therapy?
• What medications should be taken and in what dosage to reduce the percentage of the drug penetrating into milk?

Of course, not all antibiotics are suitable for use during lactation. Therefore, there should be no talk of self-treatment with antibiotics; you need to consult a doctor. The doctor will select a suitable drug for the woman that is allowed during breastfeeding. However, the task of the nursing mother is to reduce the risk of transmitting the drug to the baby as much as possible.

• Ask your doctor if you really need this medication and if it can be replaced with another, less toxic one.
• Of all the antibiotics offered, choose the one that gets into milk in a lower concentration. If the doctor advises you to stop breastfeeding, explain to him how important the need for lactation is for you and for the baby: perhaps there is a way to avoid interruptions in breastfeeding.
• In order to prevent the medicine from entering the bloodstream as much as possible, in some cases it is possible to replace antibiotic tablets with, for example, ointments or nasal sprays.
• Remember that antibiotics that are quickly cleared from the bloodstream (they need to be taken at least 3 or 4 times a day) are preferable during lactation than prolonged-release drugs (which are taken 1-2 times a day).
• Adjust the feeding time to the antibiotic intake. Ask your doctor how long after taking the pill the maximum concentration of the drug in the bloodstream occurs - it is better not to feed during this time.
• If possible, feed your baby before taking the pill. You can also express milk beforehand and save it for future feedings.
• It is best to take the tablet just before your baby's longest sleep period, for example after a night feed.
• If you doubt that the antibiotic prescribed to you is safe, and you cannot temporarily stop feeding (for example, your baby is allergic to formula), ask your doctor to monitor the content of the drug in your milk or in your baby’s blood.

Indications for the use of antibiotics during lactation

Antibiotics during lactation are prescribed only in extreme cases. There must be compelling indications for this. For example, there is the following list of diseases for which antibiotic therapy is indicated:

• tonsillopharyngitis;
• erysipelas;
• pneumonia, sinusitis, exacerbation of chronic bronchitis;
• meningitis, meningococcemia;
• sepsis;
• infective endocarditis;
• intestinal infectious diseases (shigellosis, salmonellosis);
• infectious dermatitis;
• infectious diseases of the oral cavity (periodontitis, periostitis);
• pyelonephritis;
• infectious lesions of the pelvic organs;
• osteomyelitis;
• specific infections.

During lactation, it is not recommended to use antibiotics without indications or for prophylactic purposes. The prescription of drugs must be justified.

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Release form

Antibiotics permitted during lactation can exist in various medicinal forms. The choice of form is most often determined by the convenience of taking the drug, as well as minimizing the entry of the medicinal (antimicrobial) substance into the bloodstream.

Injections – during lactation, intramuscular injection of a solution is more often used – a liquid medicinal variant, which is obtained by dissolving one or more medicinal preparations. Such a solution can be used not only directly for injections, but also for external treatment of tissues.

Tablets, coated or uncoated, are the most common type of solid dosage form, which is already labeled in appropriate doses. A tablet is a compressed version of one or more medicinal substances.

Ointments are a soft form of medicine, usually with a viscous consistency. They are used for external applications. Liniments, liquid ointments, belong to this form.

Suppositories are a form of medicine that remains solid at room temperature and melts at body temperature. They are prescribed for insertion into cavities (usually rectally or vaginally).

Drops are liquid medicinal drugs consisting of true and colloidal solutions. The dosage is administered drop by drop.

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Pharmacodynamics

It is characteristic that the more modern the generation of antibiotics, the broader the spectrum of action they have.

As a rule, antibiotics are active against streptococci, staphylococci, bacilli, enterococci, listeria, corynebacteria, neucheria, spirochetes and other microorganisms.

Some antibiotics, such as aminoglycosides, are capable of destroying Haemophilus influenzae, Shigella, Salmonella, Legionella, etc.

In any case, before prescribing a drug and starting treatment, it is recommended to conduct a test for the sensitivity of microorganisms to the action of antibiotics. Only in this case can you safely prescribe the drug that will be most effective for treatment and at the same time safe for a baby who is breastfed.

Pharmacokinetics

Most drugs can be significantly destroyed by the acidic environment of gastric juice. For this reason, antibiotics are often prescribed by injection or in capsule form (with protection from the effects of hydrochloric acid). Amoxicillin is most comfortably absorbed in the digestive system (more than 80%).

As a rule, the bioavailability of drugs depends little on the simultaneous use of food. The exceptions are ampicillin and oxacillin.

Antibiotics can be distributed in most organs, tissues and biological environments. Large amounts of active substances are observed in the respiratory organs, urinary system, intestinal mucosa, genital organs, and skeletal system. Among antibiotics approved for use during lactation, the percentage of penetration into breast milk is the lowest - less than 1%. The half-life of antibiotics can vary from 1 hour to 55 hours, so this data must be clarified, applicable to each specific antimicrobial drug.

Permitted antibiotics during lactation

Antimicrobial drugs that are acceptable to combine with breastfeeding are the following medications:

• Antibiotics of the penicillin group. Natural origin (benzylpenicillin, phenoxymethylpenicillin), semi-synthetic origin (oxacillin, ampicillin, amoxicillin, carbenicillin, ticarcillin, azlocillin, piperacillin, amoxiclav). Taking such drugs does not cause the formation of high concentrations in milk, but they should be taken with caution, as their use can cause sensitization of babies, the appearance of rashes, fungal infections and diarrhea.
• Cephalosporin group (ß-lactams). First-generation antibiotics (cefazolin, cephalexin, cefadroxil), second-generation agents (cefuroxime, cefaclor), third-generation agents (cefotaxime, ceftriaxone, ceftazidime, cefoperazone) and the fourth-generation drug cefepime. Caution should be exercised when taking cefixime and ceftibuten, as these drugs have not yet undergone sufficient clinical testing.
• Aminoglycoside group. First-generation antimicrobial agents (streptomycin, kanamycin), second-generation drugs (gentamicin, tobramycin, netilmicin), and also the third-generation drug amikacin. Note that neomycin is also a first-generation aminoglycoside, but its use during lactation is prohibited.
• Macrolide antibiotics. These drugs include erythromycin, clarithromycin, roxithromycin, spiramycin, azithromycin, josamycin and midecamycin. However, of all the listed drugs, only erythromycin is considered safe for the baby, while nursing women are advised to avoid other macrolide antibiotics.

Method of administration and dosage

The dosage of drugs for nursing women is determined only by the doctor directly at the appointment. It is highly not recommended to use drugs on your own, as well as make adjustments to the treatment regimen prescribed by the doctor.

However, there are some application features that you need to be aware of.

• Antibiotics are taken with plenty of liquid. Oxacillin and ampicillin are taken on an empty stomach, and the rest of the drugs are taken regardless of food intake.
• If the drug is taken in the form of a suspension, it should be prepared and used according to the instructions for the drug.
• It is necessary to strictly adhere to the prescribed treatment regimen, without missing doses of medication. It is advisable to take the tablets at equal intervals. If a dose was accidentally missed, it must be taken as soon as possible, but if it is already time to take the next dose, there is no need to take a double dose of the drug.
• Read the packaging carefully: under no circumstances should you use medications with an expired expiration date, as this may increase the toxic effect of the drug.
• If side effects occur, you should definitely stop taking the antibiotic and immediately tell your doctor.

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Contraindications to the use of antibiotics during lactation

Antibiotics are not used during lactation in the following situations:

• if a woman has a tendency to be allergic to antibiotics;
• in the development of undesirable symptoms in a child (disruption of intestinal microflora, signs of sensitization, skin rashes, fungal lesions of the skin, genitals, oral cavity);
• in case of serious liver and kidney dysfunction (renal and hepatic insufficiency);
• in the presence of fungal diseases in a nursing mother.

When using antibiotics during lactation, it is necessary to carefully monitor the condition and well-being of the child in order to promptly notice undesirable signs and take appropriate measures.

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Side effects of antibiotics during lactation

Taking antibiotics while breastfeeding can cause serious side effects:

• disruption of the digestive system (dysbacteriosis);
• decreased protective capacity of the body (immunity);
• disorders of the liver, urinary system, hematopoietic organs, nervous regulation, etc.

Since the medicinal substance, albeit in small quantities, still penetrates into breast milk, in particularly sensitive children this can cause adverse effects in the form of sensitization of the child's body. What does this mean?

Sensitization of a child is the development of excessive sensitivity of his body to medicines. That is, by using an antibiotic, we can activate the child's immune system to excessive susceptibility. As a result, the baby may develop allergies, diathesis and other unpleasant phenomena.

Overdose

Taking too much of the drug may increase side effects, worsen the child's condition, and cause allergic reactions. The following undesirable symptoms may also be observed:

• pain and discomfort in the abdominal area, dyspeptic disorders (nausea, vomiting, diarrhea);
• from the liver – increased transaminase activity, jaundice;
• headaches, dizziness, impaired motor coordination, hearing impairment.

At the first signs of overdose, it is important to consult a doctor. Gastric lavage may be performed, sorbent medications may be prescribed, and hemodialysis may be indicated in severe cases.

Interactions with other drugs

It is unacceptable to mix penicillin and aminoglycoside preparations in one injection – these solutions are incompatible in terms of physical and chemical characteristics.

When using benzylpenicillin potassium salt in combination with potassium-sparing diuretics or potassium-containing agents, hyperkalemia may develop.

Penicillin preparations should not be combined with blood thinning medications, as bleeding may occur.

Antacid drugs reduce the absorption of some antibiotics in the digestive tract.

Storage conditions

When buying antibiotics, it is necessary to pay attention to the conditions in which the drug should be stored, as well as the date of manufacture and expiration date - such a period, as a rule, is no more than 2 or 3 years. With the expiration of the permissible shelf life, the effectiveness of the antibiotic may decrease, and its toxicity may increase, which is especially undesirable for a nursing woman.

Moreover, expired antibiotics during lactation can provoke side effects and unexpected reactions of the body, both the mother and her child. Therefore, buy only suitable drugs that have been stored correctly: if the packaging says that the antibiotic solution should be stored in the refrigerator, and the pharmacist at the pharmacy takes the medicine for you from a regular cabinet - refrain from buying such a medicine.