Lyme Disease, Treatment and Breastfeeding

[momrn4nrsng]

I am a La Leche League Leader posting on behalf of a breastfeeding mom/friend who has been in touch with me about her diagnosis of Lyme disease. I have been in touch with other LLL Leaders who recommended contacting the Infant Risk Center. I'm hoping this mom can get some solid info and optimal and effective treatment that takes both her and her baby into consideration. Here are some details about her situation along with some specific questions, though any info or suggestions would really be appreciated!

She has one baby (first baby) who will turn 1 in mid-November.

Tick bite in the spring--May, 2011, I think. She had classic symptoms of infection including the Bull's eye rash, but was mis-diagnosed and inadequately treated at the time; a family physician prescribed an antibiotic for a couple of weeks that made her temporarily feel better, but symptoms didn't completely resolve and she developed more. Symptoms can be vague and subjective and she also questioned herself and attributed many symptoms to other causes--tired, but aren't mothers of infants often tired?...flu in the summer isn't unheard of...pain in certain joints surely because of that exercise she did.... She also has had some cognitive effects that she finds particularly alarming, and understandably so.

At some point during the summer she began seeing a physician more experienced in Lyme Disease (an expert in Lyme Disease, but not in breastfeeding & Lyme Disease, happens to be a woman) that has recognized and taken seriously her situation. M.D. has prescribed several medications, but recommends weaning before beginning treatment.

M.D. said there's no hurry to wean, but that she should go ahead and get started (I'm guessing M.D. assumes she will wean by 12 months anyway and a month or 2 sooner wouldn't make much difference.) Mom was expecting to breastfeed on the order of several years, so this is early weaning for her. We talked about telling her doctor that breastfeeding is important to her and that she's interested in considering options that will allow breastfeeding to continue. I don't know how comfortable or willing she is in talking to her doctor--she keeps saying, "I need to get well--both for myself and for my baby" and, of course, she's right about that.

Here's recent notes from her (yesterday):

"My body is experiencing pain from what the Dr said is the dead "bug" collecting in my joints as the antibiotics try to fight it. It interferes with carrying and holding my sweet baby girl as much as I like, but for the most part all is well.

"When I spoke to the Dr. last week we discussed weaning again, and she made sure I understood that we can wait a couple more months until [my baby] is more ready. Her words were " let the baby tell us how to proceed with treatment as she is ready." which is great... However it prolongs my condition from getting better. I asked again about taking all three antibiotics together and nursing and she again didn't feel comfortable doing so.

"I'll be taking azrithromiacin, cefdinair, and refambin together with a possible fourth she mentioned. So in a few months I may be a new person.

In all of this I have to be thankful that I'm not contagious or in the hospital and I can still snuggle her each day and night. I just feel so thankful to have my sweet baby and the opportunity to stay home and love on her."
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Each of the 3 medications are "L2" (at least if the meds are "Azythromycin," "Cefninir," and "Rifampin" as listed in my Hale, 2008). Does L2+L2+L2 still equal L2? or something worse? I'm sure it depends on the medications, but is there info for this mom to help her doctor feel comfortable if it is warranted or is there evidence/rationale for concern?

Something of an aside, the mom also has been taking(?) or is interested in trying(?) some herbs, etc to help with symptoms and asked:

Is "oil of oregano" o.k. to take while breastfeeding (to support bacteria/keep healthy flora)
Is tumeric (capsules) o.k. to take? (to help with inflamation)
Is garlic o.k. to take?

Thank you so much for any help!

Ruthie in NC

[cpride]

Dear Ruthie,

Taking several antibiotics together may have an additive effect that may increase the risk of diarrhea for the breastfeeding infant. With rifampin, there is also a small risk of pseudomembranous colitis. However, since her child is almost one year old, the amount of milk ingested is decreasing with foods being added to the child's diet. Also, the child's system can process medications well by now. These two factors decrease the likelihood of adverse effects for this child. To decrease the risk of diarrhea, mom can abstain from breastfeeding during the T max periods (2-4 hours) that are listed in Medications and Mothers' Milk. If the child sleeps all night, she can take the medications after the last breastfeeding session of the evening to decrease exposure even more. These medications are compatible with breastfeeding.
Herbal medications are not regulated by the Food and Drug Administration; therefore, the purity and strength may vary greatly between manufacturers. Also, there are few studies, if any, on these products; and therefore, we do not recommend them to be used during breastfeeding. The amount of the herbs you mentioned, garlic, oregano, and tumeric that are normally used in food preparation are compatible with breastfeeding. Let me know if you have further questions.

Sincerely,
Cindy Pride, MSN, CPNP
TTUHSC InfantRisk Center

[Blessing]

Ruthie,

The longer mom waits for treatment the more difficult it is to treat, it is unwise for her to wait until baby is weaned-especially because she was misdiagnosed and undertreated. I see that the moderator suggested those meds in combination are not a huge concern so it would be time to act. Also, it might be worth thinking about treating baby prophylactically.
By the time baby would show clinical symptoms the bacteria will be thoroughly embedded in her system. As always, remember that probiotics are helpful in rebalancing the gut flora when on ABX (take a few hours after ABX doses so it doesn't kill off the good bacteria). I am a member of a few Lyme support groups, current nursing mom to 18 month old. Please feel free to contact me.

[oli-vka]

Also, it might be worth thinking about treating baby prophylactically.
By the time baby would show clinical symptoms the bacteria will be thoroughly embedded in her system. As always, remember that probiotics are helpful in rebalancing the gut flora when on ABX (take a few hours after ABX doses so it doesn't kill off the good bacteria). I am a member of a few Lyme support groups, current nursing mom to 18 month old. Please feel free to contact me.

My situation is a little similar but I have been probably suffering from Lyme for years. I was diagnosed when my baby boy was 10 months old. I decided to start treatment (azithromycin, amoxicillin, hydroxychloroquine) and continue breastfeeding. I live in Poland so I contacted Center for Borreliosis in Augsburg and they said that I shoul NOT test my child for Lyme nor treat him prophylactically until he shows some signs of the disease.