Summary of use during lactation
A number of reviews have stated that tetracyclines are contraindicated during breastfeeding because of possible staining of infants’ dental enamel or bone deposition of tetracyclines. However, available literature indicates that there is not likely to be harm in short-term use of oxytetracycline during lactation because milk levels are low and absorption by the infant is inhibited by the calcium in breastmilk. Although the manufacturer recommends avoiding breastfeeding during administration of oxytetracycline, short-term use of oxytetracycline is probably acceptable in nursing mothers. As a theoretical precaution, avoid prolonged or repeat courses during nursing. Monitor the infant for rash and for possible effects on the gastrointestinal flora, such as diarrhea or candidiasis (thrush, diaper rash).
Drug levels in milk and infant serum
Maternal Levels. In an old study using a microbiologic assay, 5 women in the first week postpartum were given oxytetracycline in dosages ranging from 2 to 4 grams daily in single or divided doses. Oxytetracycline generally did not appear in milk for the first 24 hours. Concentrations then ranged from 0.25 to 1 mg/L until about a day following discontinuation of the drug.[1] In another old study using a microbiologic assay, milk oxytetracycline levels were in an unspecified number of nursing mothers at 9 am after various dosages of oxytetracycline during the previous days. Whether they had mastitis and the time postpartum were not stated. Milk levels increased to as high as 3 mg/L after a daily dose of 1.5 grams orally for 3 days. Milk levels increased to 3 mg/L after a daily dose of 2 grams orally for 3 days.[2] Two women were given 1.5 grams daily of oral oxytetracycline. Milk levels ranged from 0.7 to 1.1 mg/L with the peak occurring 7 hours after the dose. The authors estimated that a breastfed infant would receive 300 mcg daily of oxytetracycline in milk.[3] Infant Levels. Relevant published information was not found as of the revision date.
Effects in breastfed infants
No adverse effects were noted in an unspecified number of breastfed infants whose mothers were taking oral oxytetracycline 1.5 or 2 grams daily for 3 days. Ages of the infants and extent of breastfeeding were not stated.[2]
Effects on lactation and breastmilk
Relevant published information was not found as of the revision date.
Alternative drugs to consider
Doxycycline, Tetracycline
Source: Drugs and Lactation Database (LactMed®), National Institute of Child Health and Human Development, NCBI Bookshelf. Check LactMed for the most recent revision.
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