Treatment with doxycycline is being considered in a woman with a mycoplasma pneumonia, as she has d

Fråga: Treatment with doxycycline is being considered in a woman with a mycoplasma pneumonia, as she has developed an urticarial reaction to erythromycin. She is currently breast-feeding her child. Is the child (who is 8 months old) at any risk from this treatment?

Sammanfattning: There is a theoretical possibility for adverse dental effects in breast-fed infants whose mothers are treated with doxycycline. Therefore, we used to recommend that breast-feeding should be avoided during doxycycline treatment. However, this theoretical possibility seems very remote and we now therefore do not advise against using this drug in lactating women. One should also consider the age of the child in the present case and consider whether breast-feeding is still necessary.

Svar: Doxycycline is a tetracycline-like drug that passes into breast milk and theoretically may cause enamel hypoplasia in breast-fed children (1,2). Therefore, we used to recommend that breast feeding should be avoided during doxycycline treatment and for three days after treatment is stopped (1). Since doxycycline has a half-life of 15-24 hours in serum, only very small amounts can be detected after three days (1).

However, this theoretical possibility seems remote, since in infants exposed to the closely related antibiotic, tetracycline, the drug was found to be undetectable in serum. The American Academy of Pediatrics considers tetracycline compatible with breast-feeding (3,4). 1 Drugline nr 04330 (year 1984) 2 FASS 1992 3 Bennett, Drugs and human lactation, 1988 4 Briggs, Drugs in pregnancy and lactation. 1986; 2nd ed: