Antimicrobials for Dysentery in Breastfeeding Woman

Empirical Antibiotics	Dosage	Duration	Lactation
Ciprofloxacin	500mg BD	3 – 5 days	Enters breast milk / use not recommended
Norfloxacin	400mg BD		Excretion in breast milk unknown / not recommended
Levofloxacin	500mg OD		Enters breast milk / not recommended
*Azithromycin	500mg OD	3 days	Enters breast milk / use caution
*Erythromycin	500mg BD	5 days	Enters breast milk / use caution

*Use if fluoroquinolones resistance is suspected.

ü  Fluoroquinolones are not recommended to be used in lactating mothers.

ü  Either azithromycin or erythromycin can be used as both are present at low levels in breastmilk, as such adverse effects are unlikely to occur. Monitor infant for possible effects on GI tract such as diarrhea, candidiasis (thrush, diaper rash).

References:

1. UpToDate. Approach to the adult with acute diarrhea in resource-rich countries. http://www.uptodate.com/contents/approach-to-the-adult-with-acute-diarrhea-in-resource-rich-countries?source=search_result&search=dysentery&selectedTitle=1~150#H15

2. NIH. LactMed Database. http://toxnet.nlm.nih.gov/newtoxnet/lactmed.htm