Postpartum 10days with uterine infection

[Grace]

Is Teva - Cepcalexin safe for breastfeeding mother client ++ concerned with taking any Antibiotics while breastfeeding and wants to formula feed for 10 days rather then feed her baby her milk while taking two antibiotics.

metronidazole ( Flagyl) and Teva - Cepcalexin

[admin]

Grace:

I cannot find "cepcalexin". I think you mean Cephalexin. If so, it is just fine for breastfeeding. Very little enters milk.

Metronidazole levels in milk are moderate, but this drug is so safe that it is commonly used in pediatrics and even some infants.

I think the risk of formula feeding are probably much higher than the risk of these two commonly used antibiotics.

Tom Hale Ph.D.

[Christopher Clemens]

I see a much more specific and strongly-worded warning against tinidazole than metronidazole "available data demonstrates high risk of significant adverse effects to infant/breast milk production" is the wording in epocrates. Is there any reason for this? What effects are there data for?
Christopher Clemens, MD

[admin]

Dr. Clemens:

Tinidazole and metronidazole generally have stronger warnings in the breastfeeding literature because their milk levels (around 12% of maternal dose) are higher than most drugs. Also, older literature from the 80's suggested that in rodents, and using horrific doses, that metronidazol was potentially mutagenic. None of us really believe this anymore at the doses we employ in humans, and metronidazole is commonly used in pediatrics all the time.

I do not think metronidazole or tinidazole are particularly hazardous to a breastfeeding infant as long as the maternal dose is not exceedingly high. We do, however, have reports that metronidazole imparts a "metallic" taste to milk that some infants don't like.

With metronidazole, if you use the standard 500 mg BID, or 250 mg TID, then it is probably quite safe to breastfeed. If you use the 2 gram STAT dose, then the infant should be withdrawn from the breast for at least 12-24 hours, and the milk pumped and discarded. The dose in milk following a 2 gram dose could be exceedingly high, thus take the infant off the breast. With tinidazole, most of the dosing recommendations are 1-2 grams STAT. At this dose, I would recommend you interrupt breastfeeding for about 24 hours, as it has a slightly longer elimination half-life than metronidazole.

Tom Hale Ph.D.
Professor

[cpride]

Dear Donnar,

Tarivid(ofloxacin) is a typical fluoroquinolone antibiotic. The relative infant dose of ofloxacin is 3.1 percent of mother's dose (RID). The time the drug is most concentrated in breastmilk is 30 minutes to 2 hours after her dose (T max). The half-life is 5 to 7 hours. The only probable risk to the infant would be changes in the gut flora, diarrhea, and a remote risk of overgrowth of C.difficile. Dr. Hale rates this medication as L 2. Let me know if you have further questions.

Sincerely,
Cindy Pride, MSN, CPNP
TTUHSC InfantRisk Center