The M/P ratio of all commonly used penicillin derivatives is under I. As a rule, the exclusively breastfed infant receives considerably less than 1% of a therapeutic dosage (survey in Bennett 1996).
This applies similarly to cephalosporins, which are, to some extent, inactivated in the intestine (survey in Bennett 1996). Benyamini and co-workers asked 67 mothers who were taking amoxicillin plus the enzyme inhibitor clavulanic acid, as well as 38 who were taking cefuroxim, about side effects in their breastfed children (Benyamini 2005). In the first group, symptoms were more frequent (22%), as with amoxicillin alone. The symptoms were dose-dependent, however, and did not require any intervention. With cefuroxim and cefalexin, only moderate side effects were reported and in scarcely 3% of cases.
In the case of aztreonam, a 0,2% relative dosage was reported for the baby in the next breastfeed after the mother had taken a single dose (Ito 1990),
In a (apanese study of imipinem, an average of 0.8% of a weight-related, intravenously administered dosage was measured (Ito 1988).
With sulbactam, the relative daily dosage transmitted was a maximum of 1% (Foulds 1985).
4,4.3 Erythromycin and other macrolides
Aztreonam, imipinem, and sulbactam are hardly absorbed at all enterally. This provides additional support for limited bioavailability to the breastfed child.
Other 1-lactam antibiotics have not as yet been shown to be toxic for the breastfed infant.
Recommendation. Penicillin derivatives and cephalosporins are the antibiotics of choice during breastfeeding. As far as possible, substances that have been in use for a long time (e.g. second-generation cephalosporins) are preferable. When necessary, other -(-lactam antibiotics and davulanic acid can also be used.
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