Cipro vs Bactrim while BF 5 wk old

[AlaskanRNmom]

DX UTI
Written for
Cipro 250mg bid x5 days
Or
Bactrim 160/800mg bid x5 days

Which would be the better choice? I know the half life is 4-6h on Cipro and 8-10 on Bactrim but that is all I know.

Please help. Receiving mixed info from base physician and pharmacist.

Also written for Pyridium 100mg 1-2 tab po PRN
But pharmacist said NO on that and MD said yes.

Thanks !!
DeeDee RN

[admin-james]

Hi, thanks for your post.

Cipro transfers into the milk in quantities around 2-6% of the mother's daily dose. The typical prescription for a child starts at 20mg/kg/day. Half-life of Cipro is actually shorter in babies than adults (2.5h vs 4-6h). Cipro is not often used directly in babies because of the risk of GI upset and a loose association with tooth discoloration.

Bactrim's two components (sulfamethoxazole + trimethoprim) also transfer at about the same rate. Half life is significantly longer in neonates, but I believe it approaches adult numbers pretty quickly. It has a good track record of safety in full-term infants. We give Cipro and Bactrim the same safety rating, L3 (out of 5) ("Probably Compatible").

Pyridium (phenazopyridine) is not well studied in breastmilk. Its physiochemical properties predict that it will be present in milk to a limited degree and it is unlikely to be harmful to infants. However, the product doesn't actually work very well as a topical analgesic in the urinary tract. We give this med an L3 also, but with the caveat that its limited benefit might not exceed the small, somewhat vague risk involved.

Please call us at the InfantRisk Center if this has not completely answered your question.*(806)352-2519

-James Abbey, MD