Tetracycline vs. doxycycline/minocycline

[oli-vka]

As far as I know, Dr. Hale rates tetracycline L2 and doxycycline/minocycline L3 (L4 if used chronically).
I suffer from Lyme disease and still breastfeed my 11-month-old son during the night.
It may be necessary in the future (a few months) treat me with a medication from the group of tetracyclines.
I will not use doxycycline/minocycline but thin about tetracycline. Is it safe to use it chronically and still breastfeed a little a toddler?
What is the reason that tetracycline is L2 and doxycycline L4 in long-term use?

Sincerely,

oli-vka, Poland.

[admin]

Dear Dr. Oli-vka

Tetracycline is secreted into breastmilk in extremely small levels, it has a Relative Infant Dose (RID) of 0.6%-4.9% of the mother's dose. Because tetracyclines bind to milk calcium they would have reduced oral absorption in the infant. The short-term exposure of infants to tetracyclines (via milk) is not contraindicated (<3 weeks). However, the long-term exposure of breastfeeding infants to tetracyclines, such as when used daily, could cause problems. The absorption of even small amounts over a prolonged period could result in dental staining, and reduced bone growth.

Doxycycline is a long half-life tetracycline antibiotic. Doxycycline and oxytetracycline stain teeth the least severe, most tetracyclines secreted into milk are generally bound to calcium, thus inhibiting their absorption, doxycycline is the least bound (20%), and may be better absorbed in a breastfeeding infant than the older tetracyclines.

While the absolute absorption of older tetracyclines may be dramatically reduced by calcium salts, the newer doxycycline and minocycline analogs bind less and their overall absorption while slowed, may be significantly higher than earlier versions. Prolonged use (months) could potentially alter gastrointestinal flora, and induce dental staining, however doxycycline produces the least dental staining.

Short term use (three-four weeks) is probably fine. Because the enamel layer of the adult teeth begins to be created at 12 months, we don't advise long-term use of tetracyclines in breastfeeding mothers due to the risk of discoloration of the enamel of the teeth.


Tassneem Abdel Karim MD
InfantRisk Center

[oli-vka]

Thank you.
If you say "we don't advise long-term use of [all] tetracyclines in breastfeeding mothers due to the risk of discoloration of the enamel of the teeth" I think tetracycline should be rated the same as doxycycline, L4 in chronic use. Am I right? Rating it only as L2 (e.g. like azithromycin) may be misleading.

[admin]

Oli:

Yes, you should avoid chronic use.

Tom Hale

[jbc_dwb]

Is Doxycycline hyclate the same as doxycycline? Can I follow the same recommendations for short term use (3 week dose to treat acute ehrlichiosis and lyme infection) while breastfeeding? My daughter is 12 mos. and I understand this is the beginning of the formation of adult dental enamel.

[admin-james]

Yes, they are the same and we make the same recommendations.

James Abbey, MD