Tetracycline during breastfeeding

A Drug and Lactation Database states (1):

• short-term use of tetracycline is 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 diarrhoea or candidiasis (thrush, diaper rash)

A UK review states (2):

• short term use (a single course of less than 3 week’s duration) is acceptable for most tetracyclines, with precautionary infant monitoring. Long term use is generally not recommended
• tetracycline is the preferred choice in breastfeeding due to more published evidence of use in breastfeeding and negligible amounts in breast milk
• is a theoretical concern regarding bone deposition of tetracyclines and possible staining of infant’s dental enamel
  • however, these effects have not been confirmed, and are unlikely during short term use
  • as a precaution, prolonged or repeated courses should be avoided where possible during breastfeeding
• exposure to antimicrobials can affect the infant’s natural balance of microflora
  • in rare cases, antibiotic exposure has disturbed this balance and caused gastrointestinal disturbances or candidiasis
    • these effects are generally mild and resolve upon treatment discontinuation
• is a theoretical risk of hypersensitivity in the infant after exposure to antibiotics through breast milk
  • foetal exposure to antibiotics through the placenta may cause sensitisation
    • further exposure may result in allergic reactions, even from the negligible quantities seen in breast milk
• treatment choice, duration and dose should be primarily based on clinical indications and in line with national and local antimicrobial policy, with suitability in breastfeeding as a secondary consideration.

Reference:

1. Drugs and Lactation Database (LactMed®) [Internet]. Bethesda (MD): National Institute of Child Health and Human Development; 2006-. Tetracycline. [Updated 2021 Feb 23]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK501108/
2. NHS Specialist Pharmacy Service (March 28th 2024). Using tetracycline antibiotics during breastfeeding