Is Sulfamethoxazole & Trimethoprim compatible with breastfeeding? Do we have alternatives for Sulfamethoxazole & Trimethoprim?

Sulfamethoxazole & Trimethoprim

July 21, 2017 (Very Low Risk)

Mixture of 5 parts of Sulfamethoxazole and 1 part of Trimethoprim. See info on items separately.

Trimethoprim is excreted into breast milk at 4 to 10% of corrected pediatric dose.

No adverse effects have been shown in breastfed infants. Used for treatment of infants older than one month.

Sulfamethoxazole is excreted in low levels into breast milk.No adverse effects have been shown in breastfed infants. Cautious use for treatment of premature infants with hyperbilirubinemia or G-6-P-D deficiency is required. Avoid use in affected patients .

Check-up for infant jaundice.

Be aware of false negative results of bacterial cultures when the mother is on antibiotics and diarrheal disease due to intestinal flora imbalance.

The American Academy of Pediatrics rates it compatible with breastfeeding.

Eleventh WHO Model List of Essential Drugs 2002: Compatible with breastfeeding for older, healthy full- term infants.


See below the information of these related products:

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

  • Co-trimoxazole
  • TMP-SMX
  • Trimethoprim-Sulfamethoxazole

Drug trade names

References

  1. Amir LH. ABM Clinical Protocol #4: Mastitis, Revised March 2014. Breastfeed Med. 2014Abstract Full text (link to original source) Full text (in our servers)
  2. Butler DC, Heller MM, Murase JE. Safety of dermatologic medications in pregnancy and lactation: Part II. Lactation. J Am Acad Dermatol. 2014Abstract
  3. Amir LH, Pirotta MV, Raval M. Breastfeeding--evidence based guidelines for the use of medicines. Aust Fam Physician. 2011Abstract Full text (link to original source) Full text (in our servers)
  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. Spencer JP. Management of mastitis in breastfeeding women. Am Fam Physician. 2008Abstract Full text (link to original source) Full text (in our servers)
  7. Kaiser J, McPherson V, Kaufman L, Huber T. Clinical inquiries. Which UTI therapies are safe and effective during breastfeeding? J Fam Pract. 2007Abstract
  8. Forna F, McConnell M, Kitabire FN, Homsy J, Brooks JT, Mermin J, Weidle PJ. Systematic review of the safety of trimethoprim-sulfamethoxazole for prophylaxis in HIV-infected pregnant women: implications for resource-limited settings. AIDS Rev. 2006Abstract
  9. 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)
  10. 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)
  11. 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
  12. AAP - American Academy of Pediatrics Committee on Drugs. Transfer of drugs and other chemicals into human milk. Pediatrics. 2001Abstract Full text (link to original source) Full text (in our servers)
  13. Ito S, Blajchman A, Stephenson M, Eliopoulos C, Koren G. Prospective follow-up of adverse reactions in breast-fed infants exposed to maternal medication. Am J Obstet Gynecol. 1993Abstract
  14. Fulton B, Moore LL. Antiinfectives in breastmilk. Part II: Sulfonamides, tetracyclines, macrolides, aminoglycosides and antimalarials. J Hum Lact. 1992Abstract
  15. Borderon E, Soutoul JH et al. [Excretion of antibiotics in human milk]. Med Mal Infect. 1975;5:373-6. 1975
  16. Miller RD, Salter AJ.\ The passage of trimethoprim/sulpha-methoxazole into breast milk and its significance. \ Proceedings of the 8th International Congress of Chemotherapy, Athens. Hellenic Soc Chemother. 1974;1:687. 1974
  17. Arnauld R, Soutoul JH, Gallier J et al. Etude du passage de la trimethprim dans le lait maternel.\ [Study on the passage of trimethoprin into mother's milk]. Ouest Med. 1972;25:959-64.4. 1972
  18. Rasmussen F.\ Mammary excretion of sulphonamides. Acta Pharmacol Toxicol 1958; 15: 139-48. 1958