Breastfeeding Mom with mastitis and being treated with Levaquin
Mom was treated for mastitis by her OB/Gyn and prescribed Levaquin. Mom was told to stop breastfeeding and to begin giving baby formula. Is it absolutely necessary to stop breastfeeding while taking Levaquin?
Michele E. Hickman RN, CPNP
This is what we know about Levofloxacin. It's not ideal, but I doubt it is really hazardous to a breastfed infant.
I would have preferred Clindamycin, but they may have cultures to suggest Levo is best. I'd defer to the physician in this case.
In one case report of a mother receiving 500 mg/day, the 24 hour average milk level was reported to be approximately 5 µg/mL. A peak level of 8.2 µg/mL was reported, and occurred at 5 hours after the dose. The half-life of levofloxacin in milk was estimated to be 7 hours, which would result in undetectable amounts in milk after 48 hours. The authors report the absolute infant dose would be 1.23 mg/kg/day, although this was calculated from the highest milk level of 8 samples. While the peak levels were reported to be 8.2 µg/mL, the average milk level reported was 5 µg/mL. Using this data, the relative infant dose would range from 10.5% to 17%. However, the time-to-peak interval reported in this case was 5 hours, rather than 1-1.8 hours reported following both oral and IV doses in the prescribing information. Of the 10 reported levels in this study, only 1 was above 5 µg/mL. Thus the reported average level of 5 µg/mL is probably consistent with other data. This suggests a Milk/Plasma ratio of approximately 0.95 which is probably correct. Thus, levofloxacin concentrations in milk peak around 1-1.8 hours and at levels close to plasma levels. Observe the infant for changes in gut flora, candida overgrowth, or diarrhea.