Tailoring treatment: breastfeeding patients
**We will be updating this scenario soon to take into account new MHRA 2024 advice on fluoroquinolones**
Question
You’re overrunning on your ward visit and as you try to leave the Sister asks you about a patient who was discharged last night with a prescription for oral ciprofloxacin. The patient is breastfeeding her 3-month-old child and has rung the ward concerned about the risk posed to her infant having read the information leaflet. She has an intra-abdominal infection and has been prescribed ciprofloxacin 500mg twice daily for 7 days. The Sister asks you to ring the patient directly with advice on whether it is safe to breastfeed her child while taking ciprofloxacin.
Outcome
Whilst you are on the ward you check the manufacturer’s prescribing information. It confirms that ciprofloxacin should not be used whilst breastfeeding. This is because of the potential risk of joint damage to the child. However the SmPC does not give any advice about resuming feeding once the drug has been stopped.
You drop into the Medicines Information office on your way back from the ward to consult some specialist lactation resources. These advise that the amount of ciprofloxacin that passes into the breast milk is actually quite low, and that quinolones are generally considered safe to use in mothers who are breastfeeding. Waiting 3-4 hours after each dose before feeding can minimise infant exposure to the drug. Joint damage has only been reported in children taking quinolones themselves and not those exposed via the breast milk. Gastrointestinal side effects and oral candida might be expected in the child, especially with higher doses.
Armed with your findings you ring the patient at home and firstly establish that the infant was born at term and is healthy. You then explain that the risks posed to her child are actually quite low and are probably outweighed by the benefits of continuing to breastfeed. Reassured by your advice, the patient decides that she wants to resume breastfeeding. She is currently feeding her child every 4 hours and so you advise her to take the antibiotic immediately after finishing a feed if she can manage to do so. You also counsel her on the side effects that her child might experience. Finally you document your advice in the patient’s medical and nursing notes and speak to the ward Sister.
Outcome
Whilst you are on the ward you check the manufacturer’s prescribing information. It confirms that ciprofloxacin should not be used whilst breastfeeding. This is because of the potential risk of joint damage to the child. However the SmPC does not give any advice about resuming feeding once the drug has been stopped.
You drop into the Medicines Information office on your way back from the ward to consult some specialist lactation resources. These advise that the amount of ciprofloxacin that passes into the breast milk is actually quite low, and that quinolones are generally considered safe to use in mothers who are breastfeeding. Waiting 3-4 hours after each dose before feeding can minimise infant exposure to the drug. Joint damage has only been reported in children taking quinolones themselves and not those exposed via the breast milk. Gastrointestinal side effects and oral candida might be expected in the child, especially with higher doses.
Armed with your findings you ring the patient at home and firstly establish that the infant was born at term and is healthy. You then explain that the risks posed to her child are actually quite low and are probably outweighed by the benefits of continuing to breastfeed. Reassured by your advice, the patient decides that she wants to resume breastfeeding. She is currently feeding her child every 4 hours and so you advise her to take the antibiotic immediately after finishing a feed if she can manage to do so. You also counsel her on the side effects that her child might experience. Finally you document your advice in the patient’s medical and nursing notes and speak to the ward Sister.