Antibiotics and lactation: An overview of relative infant doses and a systematic assessment of clinical studies

van Wattum, J. J., Leferink, T. M., Wilffert, B. & Ter Horst, P. G. J., Jan-2019, In : Basic & clinical pharmacology & toxicology. 124, 1, p. 5-17

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  • J J van Wattum
  • T M Leferink
  • B Wilffert
  • P G J Ter Horst

Breastfeeding is important for the development of the child. Many antibiotics are considered safe during breastfeeding. The aim of the study was to assess the quality of lactation studies with antibiotics using the FDA and International Lacation Consultant Association (ILCA) quality guidelines for lactation studies. The secondary goal was to determine the exposure of the breastfed infant to antibiotics in relation to bacterial resistance and the developing microbiome. A literature search was performed and the included studies were scored on methodology, parameters concerning maternal exposure to antibiotics, maternal plasma and milk sampling. The infant exposure has been calculated and expressed as a percentage of a normal infant therapeutic dose. Sixty-six studies were included in 5 antibiotic groups (broad-spectrum penicillin, cephalosporins, macrolides and lincosamides, quinolones and sulfonamides). Cephalosporins were the most studied group of antibiotics (n=21). Fifteen studies met all the criteria of 'mother exposure to antibiotic'. Six studies met every criterion related to 'plasma sampling'. Only one case-report met all listed criteria for lactation studies. The correct calculation of infant exposure to antibiotics via the milk:plasma ratio (AUC) varies between 13% for macrolides and 38% for broad-spectrum penicillin. The highest assessed exposure as a percentage of infant therapeutic dose was for metronidazole (11%). The studies meet to a limited extent with the quality standards for lactation research. The breastfed infants are exposed to a sub-therapeutic concentration of antibiotics. This article is protected by copyright. All rights reserved.

Original languageEnglish
Pages (from-to)5-17
JournalBasic & clinical pharmacology & toxicology
Issue number1
Early online date17-Jul-2018
Publication statusPublished - Jan-2019

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