Can I Use Chloramphenicol When Breastfeeding?
Chloramphenicol is a broad spectrum antibiotic, which also possesses activity against rickettsia, chlamydia, mycoplasma and spirochetes. It is available in several formulations—oral capsules, IV injection/infusion, ear drops, and eye drops and ointment. It works by killing bacteria or preventing their growth. Chloramphenicol is used to treat serious infections in different parts of the body. It is sometimes given with other antibiotics. However, chloramphenicol should not be used for colds, flu, other virus infections, sore throats or other minor infections, or to prevent infections.
Chloramphenicol should only be used for serious infections in which other medicines do not work. This medicine may cause some serious side effects, including blood problems and eye problems. Symptoms of the blood problems include pale skin, sore throat and fever, unusual bleeding or bruising, and unusual tiredness or weakness. You and your doctor should talk about the good this medicine will do as well as the risks of taking it.
Can I use chloramphenicol when breastfeeding?
Studies have shown that Variable but relatively high milk levels have been found in breast milk of mothers taking oral chloramphenicol after single doses or multiple dose . In a study of 50 breastfed infants whose mothers were given oral chloramphenicol 1 g (n=20), 2 g (n=20), or 3 g (n=10) daily, several side effects were noted in the infants—poor sucking (100%), somnolence (50-60%), vomiting (10–90% depending on dose), and excessive abdominal gas and abdominal distension (100%).
No other studies have reported infant side effects after ingesting chloramphenicol through breast milk. In the light of this evidence systemic (oral or intravenous) chloramphenicol is normally contra-indicated in lactating mothers due to reported side effects in their infants and due to the risk, albeit theoretical, of small amounts of chloramphenicol in breast milk precipitating aplastic anaemia in the infant.
In addition, no evidence has been published relating to the levels of chloramphenicol in breast milk after administration of chloramphenicol eye drops or eye ointment to a lactating mother. Also, there have been no reported side effects in breastfed infants whose mothers have been treated with ophthalmic chloramphenicol. Despite the negligible serum levels that may be expected in a breastfed infant after maternal use of ophthalmic chloramphenicol, there is still a theoretical risk, not supported by clinical evidence, of doseunrelated aplastic anaemia
Conclusion
Systemic chloramphenicol is normally contra-indicated in breastfeeding mothers due to relatively high milk levels and reported adverse effects in breastfeeding infants, although the quality of this evidence is poor.
Ophthalmic chloramphenicol products, eye drops and eye ointment, are routinely used, and considered to be the treatment of choice for superficial eye infections.
There is conflicting evidence that ophthalmic chloramphenicol can precipitate blood dyscrasias, especially aplastic anaemia, due to systemic absorption, as this reaction is not dose-related. However, the balance of evidence suggests that the association of ophthalmic chloramphenicol and aplastic anaemia has not been established. This conclusion, therefore, also applies to the use of ophthalmic chloramphenicol in mothers who are breastfeeding their infants. It does, however, remain a theoretical risk.
There is no direct evidence on the safety of ophthalmic chloramphenicol in breastfeeding infants after maternal use. Although risks of toxicity in the infant are theoretical, and not supported by direct clinical evidence, it is advised that mothers should avoid ophthalmic chloramphenicol if clinically justifiable, using an alternative preparation containing fusidic acid if microbiologically appropriate. Ophthalmic chloramphenicol should be avoided if the infant is premature or if there is a family history of blood dyscrasias.
If chloramphenicol eye drops are considered appropriate during breastfeeding, systemic absorption can be minimised by naso-lachrymal occlusion immediately after administration.
What other information should I know?
Ask your doctor any questions you have about chloramphenicol. If you still have symptoms of infection after you finish the medication, talk to your doctor.
It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.
