Cefoxitin and Breastfeeding

Summary of use during lactation

Substantial information indicates that cefoxitin produces low levels in milk that are not expected to cause adverse effects in breastfed infants. Combined use of cefoxitin and cefuroxime can alter the milk flora and infant fecal flora.[1] Occasionally, diarrhea or thrush have been reported with cephalosporins, but these effects have not been adequately evaluated. Cefoxitin is acceptable in nursing mothers.

Drug levels in milk and infant serum

Maternal Levels. After a 1 gram dose of cefoxitin in one woman, the cefoxitin level in milk 2 hours after the dose was 5.6 mg/L.[2,3] Four postpartum women received 1 gram of cefoxitin three times a day. Only 8 of 50 breastmilk samples had measurable cefoxitin levels of 0.8 to 1 mg/L. Other samples had unmeasurable (<0.8 mg/L) cefoxitin levels.[4] Fifteen nursing others received a single intramuscular dose of cefoxitin 1 gram. Cefoxitin was not detected (<0.5 mg/L) in any milk samples taken up to 24 hours after the dose.[5] After a single 2 gram intramuscular dose of cefoxitin in 5 women, peak milk levels of 0.31 to 0.65 mg/L occurred 1 to 5 hours after the dose.[6] Cefoxitin was not measurable in breastmilk at any time up to 6 hours after a single 1 gram intravenous dose of cefoxitin in 2 women.[7] Eighteen women undergoing cesarean section were given either a single 2 gram dose of cefoxitin or 2 g followed by two 1 gram doses (route unspecified). Cefoxitin was detected (detection limit 0.5 mg/L) in the milk of only one woman at a concentration of 0.9 mg/L 19 hours after the third dose of cefoxitin.[8] Fifteen women were given a single 1 gram dose of cefoxitin intravenously at about 1 month after delivery. The average milk level 2 hours after the dose was 0.05 mg/L.[[9] Five women were who had been receiving intravenous cefoxitin 1 gram twice daily for 2 days following cesarean section each donated a milk sample. The highest milk concentration was 1.71 mg/L at 1 hour after the dose in one woman. Drug concentrations in samples taken at 1.5 or 2 hours after the dose in 3 women ranged from 0.71 to 0.94 mg/L. A fifth woman who donated a milk sample at 2.5 hours after the dose had a milk cefoxitin concentration of 0.57 mg/L.[10] 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.

References

1. JiC ZhangG XuS Antibiotic treatments to mothers during the perinatal period leaving hidden trouble on infants. Eur J Pediatr 2022 181 3459 71 35680662 PubMed
2. GeddesAM SchnurrLP BallAP Cefoxitin: A hospital study. Br Med J 1977 1 1126 8 861496
3. GeddesAM McGhieD BallAP Studies with cefuroxime and cefoxitin. Scand J Infect Dis Suppl 1978 13 78 81 308260
4. SantoGH HuchA Ubergang von cefoxitin in muttermilch. Infection 1979 7 Suppl 1 S90 S91
5. DuboisM DelapierreD ChanteuxL A study of the transplacental transfer and the mammary excretion of cefoxitin in humans. J Clin Pharmacol 1981 21 477 83 7334140 PubMed
6. DresseA LambotteR DuboisM Transmammary passage of cefoxitin: Additional results. J Clin Pharmacol 1983 23 438 40 6643697 PubMed
7. MatsudaS. Transfer of antibiotics into maternal milk. Biol Res Pregnancy Perinatol 1984 5 57 60 6743732 PubMed
8. RoexAJ van LoenenAC PuyenbroekJI Secretion of cefoxitin in breast milk following short-term prophylactic adminstration in caesarean secretion. Eur J Obstet Gynecol Reprod Biol 1987 25 299 302 3653494 PubMed
9. ZhangY ZhangQ XuZ. [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
10. KiriazopoulosE ZaharakiS VonapartiA Quantification of three beta-lactam antibiotics in breast milk and human plasma by hydrophilic interaction liquid chromatography/positive-ion electrospray ionization mass spectrometry. Drug Test Anal 2017 9 1062 72 27714984 PubMed