Oxacillin and Breastfeeding

Summary of use during lactation

Limited information indicates that oxacillin 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 penicillins, but these effects have not been adequately evaluated. Oxacillin is acceptable in nursing mothers.

Drug levels in milk and infant serum

Maternal Levels. After 3 to 4 doses of oxacillin 500 mg orally in 10 women, the highest level detected was 0.2 mg/L in two women 4 hours after the dose. In the other 8 women, milk levels were less than 0.2 mg/L at times between 1 and 3.75 hours after the dose.[1] One woman received oral oxacillin 3 grams daily. After the third dose, milk oxacillin levels ranged from 0.04 to 0.1 mg/L, with the peak occurring at 3 hours after the dose. The authors estimated that a breastfed infant would receive 0.3 mg daily of oxacillin in milk.[2] In 10 women with mastitis who received 1 gram of oxacillin orally 3 times daily for 5 to 6 days, the average milk concentrations ranged from 0.43 to 0.68 mg/L.[3] Repeated injections of oxacillin 1 gram intramuscularly every 6 hours for 6 to 9 days in 15 women with unilateral mastitis yielded oxacillin milk levels that reached a peak of 0.49 mg/L at 3 hours after the first dose on the first day in the healthy breast, and somewhat lower levels in the breast with mastitis. After the last dose, peak milk levels of 0.64 mg/L occurred 6 hours after the dose in the unaffected breast with slightly lower levels in the breast with mastitis.[4] After a single intramuscular dose of 500 mg of oxacillin in 2 women, milk levels ranged from 0.18 to 0.7 mg/L between 1 and 4 hours, with the peak occurring at 2 to 4 hours after the dose. Only a trace was detectable at 6 hours after the dose.[5] In 15 women given a single 1 gram dose of oxacillin intravenously, milk levels averaged 0.68 mg/L at 2 hours after the dose.[6] Infant Levels. Ten women with mastitis received 1 gram of oxacillin orally 3 times daily for 5 to 6 days. Oxacillin was detectable in the urine in 5 of 6 of the breastfed infants in whom it was measured. Urine concentrations ranged from 0.2 to 3.7 mg/L.[3]

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

References

1. Var L, Ince I, Topuzoglu A, et al. Management of postpartum manic episode without cessation of breastfeeding: A longitudinal follow up of drug excretion into breast milk. Eur Neuropsychopharmacol 2013;23 (Suppl 2):S382. https://www.sciencedirect.com/journal/european-neuropsychopharmacology/vol/23/suppl/S2
2. Borderon E, Soutoul JH, Borderon JC, et al. Excretion of antibiotics in human milk. Med Mal Infect 1975;5:373-6
3. Peiker G, Schroder S. The concentration of oxacillin and ampicillin (Penstabil) in mother's milk in puerperal mastitis. Pharmazie 1986;41:793-53562514 PubMed
4. Kulakov VI, Zak IR, Kulikova NN, et al. Body pharmacokinetics of methicillin, oxacillin and cephaloridine in puerperal mastitis. Antibiotiki 1981;26:110-37212690 PubMed
5. Matsuda S. Transfer of antibiotics into maternal milk. Biol Res Pregnancy Perinatol 1984;5:57-606743732 PubMed
6. 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;32:288-929596854 PubMed