Dapsone nitrofurantoin and other drugs for urinary tract infections

Experience

In the case of therapy with dapsone, 10-20% of the weight-related dosage can pass into the milk (Edstein 1986, Sanders 1982). In a case description, dapsone and its primary metabolite, monoacetyl-dapsone, were documented in the child's serum. The infant developed hemolytic anemia (Sanders 1982).

After a single dose of lOOmg nitrofurantoin to four women, an average of 1.3 ng/ml was measured in the milk; the maximal measurement (about 5 hours after administration) was 3.2 ng/ml. The M/P ratio was 6 (Gerk 2001). Based on these values, the relative dose for a fully breastfed child can reach 10%. Older investigations determined only 2.5% (Pons 1990). Haemolytic reaction of a baby with glucosc-6-phosphate-dehydrogenase deficiency was described in an older report. Apart from such a constellation, threatening effects are not to be expected for a breastfed child - particularly one who is older than 4 weeks.

Sulfonamides pass into the mother's milk in various amounts. The percentage specifications, based on the weight-related maternal dosage, vary between 1% and over 50% {in the case of the old sulfonamid, sulfanilamide).

With sulfamethoxazole, the sulfonamide portion in cotrimoxa-zole is, on average, 2%.

For trimethoprim, an average of 4-5.5% of the relative dosage was calculated for the exclusively breastfed infant with a 5-day treatment with cotrimoxazole (survey by Bennett 1996).

There are no data on fosfomycin and tetroxoprim.

Recommendation. Cotrimoxazole or trimethoprim alone (which is mostly just as effective as cotrimoxazole as monotherapy for urinary tract infections) can be used for appropriate indications. If actually indicated, nitrofurantoin and sulfonamides can also be prescribed. In the case of necessary treatment with dapsone, an individual decision must be made about limiting breastfeeding.

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New Mothers Guide to Breast Feeding

New Mothers Guide to Breast Feeding

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