Antibiotics and Breastfeeding: Which Are Safe and Which Are Unsafe?

Moms get sick, too. While not all illnesses or medical conditions require antibiotics, some, such as sinus or ear infections, mastitis, or dental procedures, may require them (1). If your doctor has prescribed you an antibiotic during breastfeeding phase, it’s totally justified if you want to know about its safety and whether it can affect your baby through breast milk. There’s a lot of unverified information out there regarding antibiotics and breastfeeding. Getting verified information helps reduce a ton of stress. Scroll through the article to gain the best knowledge regarding the use and safety of antibiotics when breastfeeding.

Is it Safe to Take Antibiotics While Breastfeeding?

Breastmilk is the only food that a baby takes for the first six months, not a few weeks. Also, not everything a mother eats reaches the baby through breastmilk or affects the baby. The general rule is not to take OTC ever. Especially when breastfeeding. Always mention to the doctor that you are breastfeeding and to give breastfeeding-friendly medication, check on the medication information both on the box/container or Lactmed on the internet to see if the medication is breastfeeding-friendly, and ask for alternatives if it is not.

So, what does that mean for you and your nursing baby?

Also, the general rule of thumb is that if it’s safe while pregnant, it’s safe while breastfeeding too.

According to the Mayo Clinic, a majority of medications taken orally go into breastmilk. But here’s a catch. Most of the time, the amount of drugs in your milk is usually lower than the amount in your blood, and that’s unlikely to pose a risk to your baby. However, some medications can be present in high levels in the breast milk. Thus, it’s highly important that your doctor knows about your breastfeeding situation and the supplements or medicines you are currently on before they prescribe you a new or additional one.

The baby’s age and overall health also play an important role in determining how the body will respond to the chemicals in the antibiotic. Premature babies, newborns, and babies who have many kidney or other health issues are at a greater risk of exposure to antibiotics than older babies and toddlers (2).

The impact of antibiotics on lactation also depends on the type of medicine and the prescribed dosage. Every prescribed medicine you take, including antibiotics, should be cleared with your baby’s paediatrician.

If it is considered safe for your baby, it is safe to take while breastfeeding.

It is also highly recommended that the mother take probiotics while taking antibiotics. Antibiotics kill bacteria in general, including both good and bad bacteria in the gut; this has to be replaced, which is why probiotics are needed.

Do All Antibiotics Pass Into Breastmilk?

According to the Mayo Clinic and La Leche League GB, some orally consumed medications can pass into breast milk through a process called diffusion, in minimal amounts unlikely to pose a threat to your infant. Several factors affect whether a substance will enter milk and in what amounts. However, some medications may be present in significant concentrations in breast milk. It’s important to discuss with your healthcare provider regarding every medication and supplement you are using (2) (3).

Factors That Determine the Effects of Antibiotics on Infants

Different antibiotics may have different effects on your baby depending on various factors. The following are the factors that determine how an antibiotic will affect your baby:

1. Composition of the Breast Milk: Chemical compounds that form antibiotics have a greater tendency to mix with milk, which has higher protein content. This situation is more predominant in the case of premature babies, as the mother’s body produces milk with more protein than it would in the case of normal babies. Extra care is required before consuming any antibiotics in this case.
2. Baby’s Age and General Health: Babies less than two months are most prone to adverse effects of antibiotics since their liver and kidneys are still developing and not mature enough to flush out antibiotics. The adversity reduces once they cross six months.
3. Combination of Antibiotics Consumed: It is possible that if a safe antibiotic is consumed with other medicines, the drugs may cause a reaction and form compounds which may harm the baby. It is, therefore, a must to discuss with your doctor before taking any medicine.
4. Composition of the Drug: The composition of the antibiotic is an important determinant of its effect on the baby. Some compounds have a higher rate of binding with proteins present in the milk, which may transfer higher quantities to the baby.

Safe Antibiotics While Breastfeeding

The safety of antibiotics is typically evaluated individually, taking into account the baby’s age, weight, and general health. The consumption of antibiotics must be strictly monitored by the baby’s paediatrician and your prescribing, and no medicine should be taken without due consultation. The following is a list of antibiotics that are safe for breastfeeding:

Unsafe Antibiotics During Lactation

Following is a list of drugs and antibiotics for breastfeeding mothers which are considered unsafe and should be avoided:

Are There Any Harmful Effects of Antibiotics?

Antibiotics may be safe for breastfeeding, but will always leave a negative impact on the mother’s and baby’s gut, thereby resulting in loose motions and temporary lactose intolerance. It is best that a lactating mother, when she consumes antibiotics, also increases her intake of probiotics and prebiotics.

Consumption of non-prescribed antibiotics by the mother can lead to the following problems in the baby:

1. May cause diarrhoea: A baby’s gut had underdeveloped strains of ‘good bacteria’ that help in the digestion of food. Antibiotics not only target the disease-causing bacteria but also harm the beneficial bacteria. In such cases, giving probiotics to the baby can be helpful in countering the antibiotics and restoring the balance of your baby’s gut flora.
2. May cause sepsis: Sepsis is caused when a pathogen causes the immune system to overreact and damage healthy tissues of the body. Antibiotic use can cause the baby’s weak immune system to react aggressively, leading to sepsis. 
3. Change in temperament: Taking antibiotics may cause the baby to feel a little unsettled and uncomfortable. Colic-like symptoms might appear. 
4. Thrush: Antibiotics may also cause thrush in the mother and/or the baby. It is a condition in which the mother’s gut flora is affected by consuming these medicines.

Things to Discuss With the Doctor

During the consultation, it is important for you to let your doctor know all about your pregnancy, the nature of the problems that you have come for and any medication that you are already taking or have been asked to specifically avoid. Also, inform us of any medical conditions or allergies you have.

In addition, the following are the things you would like to inform and discuss with your doctor about antibiotics and breastfeeding:

1. Inform the doctor about the fact that you are lactating. This will help them avoid medicines that are not suitable for the baby.
2. It is important to share your baby’s age and general health condition with the doctor. Also, inform if the baby is under any kind of medication.
3. Discuss with your doctor the possibility of avoiding antibiotics.

How to Avoid the Risks of Antibiotics in Babies?

The best way to avoid the side effects of antibiotics is by not having them. However, if you have to take it, follow these steps to avoid risks of adverse effects on your baby.

1. If possible, choose antibiotic ointments and creams instead of consuming them orally. This will help to prevent the transfer of breastmilk.
2. Request the doctor to prescribe antibiotics that are safe for the baby.
3. Antibiotics with poor oral bioavailability in infants pass out of their digestive system without causing any harm. Prefer consumption of such antibiotics.
4. Ensure that you take a dose right after breastfeeding so that the time gap between consumption and the next breastfeeding session is maximum.

While most antibiotics are considered to be safe for lactating mothers, it is best to consume them only after consultation and prescription from the doctor.

FAQs

1. Is it safe to take antibiotics while breastfeeding?

Many antibiotics are considered safe during breastfeeding, as only small amounts pass into breast milk. However, the safety depends on the specific antibiotic, so medical guidance is essential before starting any medication.

2. Can antibiotics affect my breastfed baby?

Some babies may experience mild side effects, such as loose stools, fussiness, or temporary changes in gut flora. Serious reactions are rare, but any unusual symptoms should be discussed with a healthcare provider.

3. Should I stop breastfeeding while taking antibiotics?

In most cases, breastfeeding does not need to be stopped. Doctors usually prescribe antibiotics that are compatible with breastfeeding. Stopping unnecessarily may affect milk supply and the baby’s feeding routine.

4. Are there antibiotics that should be avoided during breastfeeding?

Yes, certain antibiotics are not recommended due to potential effects on the baby. Always inform your doctor that you are breastfeeding so they can prescribe a suitable and safe option.

The first few weeks after birth are very fragile for your baby. In this period, the essential organs are still developing, and the immune system is not very strong to protect them. It is, therefore, very important to be extremely cautious before consuming anything, especially antibiotics. While it is considered safe to take antibiotics only when prescribed by a doctor, it is important to avoid excessive use; only the prescribed dosage should be taken. If the usage of medicines cannot be avoided, take only those medicines which have been prescribed by your doctor. Eat a healthy, nutritious diet to reduce the impact of antibiotics on the baby.

Also Read:

Calcium While Breastfeeding
Postnatal Vitamins for Breastfeeding Moms
Can You Take Vitamin C While Breastfeeding?

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Sources References

1. National Library of Medicine – Mastitis While Breastfeeding: Prevention, the Importance of Proper Treatment, and Potential Complications

2. Mayo Clinic – Breastfeeding and medications: What’s safe?

3. La Leche League GB – Breastfeeding and a Mother’s Diet: Myths and Facts

4. Cleveland Clinic – Penicillin

5. National Library of Medicine – Cephalosporins

6. Cleveland Clinic – Macrolides

7. National Library of Medicine – Clindamycin

8. The Breastfeeding Network – Antibiotics and Breastfeeding

9. MotherToBaby – Tetracycline