Is Doxycycline compatible with breastfeeding? Do we have alternatives for Doxycycline?

Doxycycline

August 6, 2018 (Low Risk)

Indicated in the treatment of infections caused by Mycoplasma pneumoniae, Chlamydia, Rickettsia and spirochetes.
Oral administration once a day.

Excreted into breast milk in quantities that would be clinically significant (Matsuda 1984, Lutziger 1969, Morganti 1968), however, intestinal absorption by infant's gut is hampered because of formation of chelating products by union with the milk's calcium (Chin 2001).

Tetracycline is at lesser amount excreted into breast milk and at higher proportion bound to calcium, hence, it is fewer absorbed than Doxycycline (Hale 2017 p312, Chin 2001).

Long-term treatments are not recommended (over 3-4 weeks) since it may cause damage of the growth cartilage, teeth discoloration and imbalance of intestinal flora.

Several medical societies, experts and expert consensus, consider the use of this medication safe or probably safe during breastfeeding (Hale 2017 p312, Briggs 2017, Rowe 2013, Chen 2010, Mitrano 2009, Nahum 2006, Mahadevan 2006, WHO 2002, Chin 2001).

Be aware of false negative results of bacterial cultures obtained from febrile infants whose mothers are on antibiotics, as well as the possibility of gastroenteritis due to altered intestinal flora (Briggs 2017, Ito 1993).

Alternatives

Very Low Risk

Compatible. Not risky for breastfeeding or infant.

Low Risk

Moderately safe. Mild risk possible. Follow up recommended. Read the Comment.

High Risk

Poorly safe. Evaluate carefully. Use a safer alternative. Read the Comment.

Very High Risk

Not recommended. Cessation of breastfeeding or alternative.

Synonyms

  • Doxiciclina fosfatex
  • Doxycycline Calcium
  • Doxycycline Hyclate
  • Doxycycline Monohydrate

Writings

  • Δοξυκυκλίνη (Greek)
  • دوكسيسيكلين (Arabic)
  • Доксициклин (Cyrillic)
  • 多西环素 (Chinese)
  • ドキシサイクリン (Japanese)
  • C22 H24 N2 O8, H2O (Molecular formula)
  • (4S,4aR,5S,5aR,6S,12aS)-4-Dimethylamino-1,4,4a,5,5a,6,11,12a-octahydro-3,5,10,12,12a-pentahydroxy-6-methyl-1,11-dioxonaphthacene-2-carboxamide monohydrate; 6-Deoxy-5β-hydroxytetracycline monohydrate (Chemical name)
  • A01AB22; J01AA02 (ATC Code/s)

References

  1. Briggs GG, Freeman RK, Towers CV, Forinash AB. Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk. Wolters Kluwer Health. 11th edition (acces on line) 2017
  2. Hale TW, Rowe HE. Medications & Mothers' Milk. A Manual of Lactation Pharmacology. Springer Publishing Company. 2017
  3. Rowe H, Baker T, Hale TW. Maternal medication, drug use, and breastfeeding. Pediatr Clin North Am. 2013 Feb;60(1):275-94. 2013Abstract
  4. Chen LH, Zeind C, Mackell S, LaPointe T, Mutsch M, Wilson ME. Breastfeeding travelers: precautions and recommendations. J Travel Med. 2010Abstract Full text (link to original source) Full text (in our servers)
  5. Mitrano JA, Spooner LM, Belliveau P. Excretion of antimicrobials used to treat methicillin-resistant Staphylococcus aureus infections during lactation: safety in breastfeeding infants. Pharmacotherapy. 2009Abstract
  6. Nahum GG, Uhl K, Kennedy DL. Antibiotic use in pregnancy and lactation: what is and is not known about teratogenic and toxic risks. Obstet Gynecol. 2006Abstract
  7. Mahadevan U, Kane S. American gastroenterological association institute technical review on the use of gastrointestinal medications in pregnancy. Gastroenterology. 2006Abstract Full text (link to original source) Full text (in our servers)
  8. WHO / UNICEF. BREASTFEEDING AND MATERNAL MEDICATION Recommendations for Drugs in the Eleventh WHO Model List of Essential Drugs. Department of Child and Adolescent Health and Development (WHO/UNICEF) 2002 Full text (link to original source) Full text (in our servers)
  9. Chin KG, McPherson CE 3rd, Hoffman M, Kuchta A, Mactal-Haaf C. Use of anti-infective agents during lactation: Part 2--Aminoglycosides, macrolides, quinolones, sulfonamides, trimethoprim, tetracyclines, chloramphenicol, clindamycin, and metronidazole. J Hum Lact. 2001Abstract
  10. Fulton B, Moore LL. Antiinfectives in breastmilk. Part II: Sulfonamides, tetracyclines, macrolides, aminoglycosides and antimalarials. J Hum Lact. 1992Abstract
  11. Matsuda S. Transfer of antibiotics into maternal milk. Biol Res Pregnancy Perinatol. 1984Abstract
  12. Lutziger H. [Concentration determinations and clinical effectiveness of doxycycline (Vibramycin) in the uterus, adnexa and maternal milk]. Ther Umsch. 1969Abstract
  13. Morganti G, Ceccarelli G, Ciaffi G. [Comparative concentrations of a tetracycline antibiotic in serum and maternal milk]. Antibiotica. 1968Abstract