Chloramphenicol, quinolones, and streptomycin arc usually con-traindicated. However, the total dose of active principal could be calculated and may well be below the level of concern when given by drops to the eye or car.
Eye treatments include dilators, constrictors, antibiotics, antiinflammatories, and artificial tears. Most of these are in small doses and work only locally.
Atropine (belladonna) drops have the potential for systemic absorption, but do not pose a problem unless the dose is taken too frequently, which tends to be an issue with the elderly rather than with women in their childbearing years. Atropine is absorbed from the eye quickly, peaks systemically within an hour and clears in less than 24 hours (half-life 4 hours). Atropine docs dry secretions, so continued use has the potential for reducing milk production.
Anti-inflammatories that are used in the eye are usually corticosteroids. The dose that is absorbed systemically is minimal, and well below the acceptable daily intake for a lactating woman. There were no symptoms observed in a breastfed infant whose mother was treated with eye drops containing timolol, dipivefrin, and dor-zolamid. and who occasionally took acetazolamid orally (Johnson 2001), Acetazolamid and timolol have been categorized as acceptable during lactation by the American Academy of Pediatrics (2001), as no side effects have been reported.
Other pharmacologically active compounds may be administered via these routes, and may be an issue.
The safest therapy for an acute upper respiratory infection (URI or cold) is not with systemic vasoconstrictors or decongestants, which can decrease milk production, but with local treatment. Nose drops which shrink mucous membranes (pseudoephedrine) are given in small doses and provide relief locally, and do not interrupt breastfeeding.
Ear drops work locally in the ear canal, and do not represent a problem as they are not absorbed. Most are antibiotics or antifungals.
Recommendation. Medication by drops in the eye, ear, and nose are usually compatible with breastfeeding. Ophthalmic atropine can be an issue if used chronically, as it may decrease milk production. Preparations for the eyes or ears that contain chloramphenicol, quinolines, and streptomycin should be avoided.
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