Cefazolin and Breastfeeding

Summary of use during lactation

Limited information indicates cefazolin produces low levels in milk that are not expected to cause adverse effects in breastfed infants. Occasionally disruption of the infant's gastrointestinal flora, resulting in diarrhea or thrush have been reported with cephalosporins, but these effects have not been adequately evaluated. Cefazolin is acceptable in nursing mothers.

Drug levels in milk and infant serum

Maternal Levels. After a single 500 mg dose of cefazolin intramuscularly to 4 women, cefazolin was barely detectable in the mother's milk and not detected in their breastfed infants' serum.[1] After intramuscular doses of cefazolin 500 mg three times daily in 10 women, the peak concentration of cefazolin in milk was 0.9 mg/L.[2] Twenty women were given 2 grams of cefazolin intravenously over 10 minutes. Average milk levels were 1.25 mg/L at 2 hours, 1.51 mg/L at 3 hours and 1.16 mg/L at 4 hours after the dose.[3] After a single dose of 1 gram of cefazolin given intravenously to 15 women who were 1 month postpartum, milk cefazolin levels averaged 0.75 mg/L 2 hours after the dose.[4] Infant Levels. Relevant published information was not found as of the revision date.

Effects in breastfed infants

Relevant published information was not found as of the revision date.

Effects on lactation and breastmilk

Relevant published information was not found as of the revision date.

Alternative drugs to consider

(Methicillin-sensitive Staph. aureus) Cephalexin, Dicloxacillin, Floxacillin, Oxacillin, Methicillin, Nafcillin; (Methicillin-resistant Staph. aureus) Doxycycline, Linezolid, Minocycline, Trimethoprim-Sulfamethoxazole, Vancomycin

References

1. Fukada M. Studies on chemotherapy during the perinatal period with special reference to such derivatives of cephalosporin C as cefazolin, cephaloridine and cephalothin. Jpn J Antibiot 1973;26:197-214.4542543 PubMed
2. von Kobyletzki D, Reither K, Gellen J, et al. Pharmakokinetische untersuchungen mit cefazolin in geburtshilfe und gynakologie. Infection 1974;2 (Suppl 1):60-7.
3. Yoshioka H, Cho K, Takimoto M, et al. Transfer of cefazolin into human milk. J Pediatr 1979;94:151-2.758399
4. Zhang Y, Zhang Q, Xu Z. Tissue and body fluid distribution of antibacterial agents in pregnant and lactating women. Zhonghua Fu Chan Ke Za Zhi 1997;32:288-92.9596854 PubMed