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Use of Antibiotic and Analgesic Drugs during Lactation

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Abstract

During lactation, multiple situations can arise that require maternal pharmacological treatment. Because of the many health advantages of human milk to infants, breast feeding should be interrupted only when the needed drug might be harmful to the nursing child and exposure via the breast milk will be sufficient to pose a risk. Since the majority of drugs have not been shown to cause adverse effects when used during lactation, and even temporary interruption of breast feeding can be difficult for the nursing dyad, decisions regarding maternal medication use during breast feeding should be based on accurate and up-to-date information. This article reviews available data on the most commonly used antibiotics and analgesics.

The use of most antibiotics is considered compatible with breast feeding. Penicillins, aminopenicillins, clavulanic acid, cephalosporins, macrolides and metronidazole at dosages at the low end of the recommended dosage range are considered appropriate for use for lactating women. Fluoroquinolones should not be administered as first-line treatment, but if they are indicated, breast feeding should not be interrupted because the risk of adverse effects is low and the risks are justified.

Paracetamol (acetaminophen), low-dose aspirin (acetylsalicylic acid) [up to 100 mg/day] and short-term treatment with NSAIDs, codeine, morphine and propoxyphene are considered compatible with breast feeding.

Safer alternatives should be considered instead of dipyrone, aspirin at a dosage >100 mg/day and pethidine (meperidine).

In the light of the many safe alternatives for pain control, breast-feeding mothers should not be allowed to experience pain or be made to feel that they must choose between analgesia and breast feeding.

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Acknowledgements

No sources of funding were used to assist in the preparation of this review. The authors have no conflicts of interest that are directly relevant to the content of this manuscript.

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Authors and Affiliations

  1. Department of Neonatology, Hadassah University Hospital, Mount Scopus, Jerusalem, Israel

    Benjamin Bar-Oz

  2. Clinical Pharmacology and Toxicology Unit, Sackler School of Medicine, Assaf Harofeh Medical Center, Tel-Aviv University, Tel-Aviv, 70300, Zerifin, Israel

    Mordechai Bulkowstein, Lilach Benyamini, Revital Greenberg, Ingrid Soriano, Oxana Bortnik &  Matitiahu Berkovitch

  3. TEREM-Immediate Medical Services, Jerusalem, Israel

    Deena Zimmerman

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Bar-Oz, B., Bulkowstein, M., Benyamini, L. et al. Use of Antibiotic and Analgesic Drugs during Lactation. Drug-Safety 26, 925–935 (2003). https://doi.org/10.2165/00002018-200326130-00002

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