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3 1/2 week postpartum client dx with MRSA...taking sulfamethoxazole/trimethoprim

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  • 3 1/2 week postpartum client dx with MRSA...taking sulfamethoxazole/trimethoprim

    for 2 weeks. She was told she cannot breastfeed. Is this indeed true? Currently she is mixing breastmilk with formula so what she pumped in advance will last longer. She would really like to breastfeed.

  • #2
    KellyO:

    Remember, sulfonamides displace bilirubin off its albumin binding site, thus worsening kernicterus. So we always suggest caution using sulfonamides during the early postnatal period, particularly in infants with hyperbilirubinemia.

    However, at 3.5 weeks, this infants bilirubin is "probably" quite low and it would probably be quite safe to breastfeed at this time. Again, it all depends on the infants bilirubin levels.

    Tom Hale Ph.D.

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    • #3
      This baby had nothing more than mild transient jaundice during the first few days. Would it be worth asking the pediatrician to test bilirubin and if at normal levels for a near 4 week old baby, it would be considered safe to resume nursing? It just seems to me that, if this is the sole concern, then resuming breastfeeding would be preferable to 2 weeks of formula and the possibility of a reduced supply at the end of the course of abx. (And FWIW the MRSA infection is nowhere near the breast.) Or would there be any benefit to pumping just before the next dose of abx and feeding that to the baby...that the drug would be at its lowest level at that point? Thanks in advance for any information. Just trying to maximize breastmilk and minimize formula for this baby.

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      • #4
        KellyO:

        Surely they could do a skin bilirubin test. If low then no problem with the sulfonamides.

        Tom Hale

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        • #5
          Hi,

          my wife recently went through an incision for a breast abscess. In the initial stages of needle aspiration, the culture showed heavy staph. However, after the incision, the fluid from the incision showed light staph, but MRSA. The doctors changed her antibiotics from Cephilex to sulfamethoxazole/trimethoprim. Our daughter (full term natural delivered baby) had to be treated for Jaundice when she was first born, but last we checked when she was about 3 weeks old the levels were really low.

          Would it be safe to breast feed knowing:
          1) my wife has MRSA on her open wound from the incision on the left breast
          2) She's taking sulfamethoxazole/trimethoprim

          Thanks ,

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          • #6
            Albliu:

            Yes, the only complication to using sulfamethoxazole/trimethoprim in a mother with a breastfeeding infant is a syndrome G6PD, or elevated bilirubin levels. The elevated bilirubin levels occur about the first 20 days postpartum, this it should be no problem at all for your infant.

            Tom Hale Ph.D.

            Comment


            • #7
              I am almost 4 weeks postpardum, my daughter will be a month on the 14th. She was born at 36 weeks and 3 days at 6 pounds and 5 ounces 19 inches, and had no issues with her health.
              I went to the hospital for an infection in my eyelid and was prescribed sulfamethoxazole tmp 1 time tablet twice a day for 7 days, along with clindamycin hcl 300mg one capsule 3 times a day for 10 days. I was told I would not be able to breast feed for about 3 weeks from the last pill I take once the 10 days are over. Since Friday I have been pumping and dumping. I read that as long as I wait 24 hours from when I take the Last pill I am ok to breastfeed. In this case what should I do?

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              • #8
                Storres56:

                I'm sorry, but you received poor information, you can breastfeed with both of these medications. We are a bit cautious early postnatally in "hyperbilirubinemic" children, but if your child did not have elevated bilirubin levels, you could probably have breastfed with these drugs earlier. I'd go ahead an start whenever.


                Tom Hale Ph.D.;

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                • #9
                  Thank you very much !! What a relief that I can start breastfeeding now.

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                  • #10
                    Are they any symptoms in the baby I should look out for?

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                    • #11
                      Elevated bilirubin, but I think it is really unlikely at this point.

                      Tom Hale

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