BFing Mommas... PLEASE HELP ME!!! Breast abscess. PIOG

[Mrs.Seale]

So I noticed a little bump this past Tues. and looked around on the internet and realized that it was probably a clogged milk duct so I nursed, nursed, nursed on that side. My LC told me that if I developed a fever, however, that I needed to go to the Dr. I got a low grade fever on Wednesday and it just kept  getting higher. So on Friday, I made an appt for myself and found out that it had developed into Mastitis. YAY!! Got me some antibiotics and thought all was well until I woke up this morning in a pool of pus coming from where the duct was. I called and had the on-call Dr. call me and he suggested that I go into the ER. They actually fast-tracked me and they got it drained but the ER Doc said that he needed to put me on a 2nd antiboitic. No big deal, right? Wrong. The two meds that I'm on (according to ER Doc) can make the baby sick so he said to stop BFing until I'm back down to 1 med. GRRRR!!!! My supply is diminishing anyway and now to pump for 8 days straight? I'm SO scared that I"m going to dry up. So, how do I pump that long and still keep my supply up so that (assuming  she doesn't start to prefer the bottle) I can BF again? I was only able to BF my first 2 kiddos for a few weeks so I REALLY want to stay with this as long as I possibly can. Please help me. And and ALL suggestions will be greatly appreciated.

[jothra]

Call the LC and/or the OB and ask them. I've learned that not all ER docs know everything about nursing babies.

[tabi_cat1023]

Ok doctors are BFing idiots, they mean well but have NO idea about meds...they once told me Diflucan was not safe to nurse on.

Give me the meds and I will look them up and give you the info...

reliable info from Dr. Hales medication and mothers milk AND the national library of medicines medication database for lactation.

I bet you can get back to nursing

[Mrs.Seale]

Doc on Friday game me dicloxicillin 500mg and er doc today gave me clindamycin 260mg. They are both antibiotics. He also game me some oxycodone for the pain and body aches.

[MomofWildcats]

I externed in an urgent care and we had one patient with infected milk ducts... the Dr I was working for gave her an antibiotic and told her to follow up the next day with her OB because he didn't know much about breast feeding... I admire his honesty for that... but I also think thats what you need to do and its too bad the ER doc didn't tell you that because they really don't know everything about BF'ing.

[tabi_cat1023]

Quoting Mrs.Seale:

Doc on Friday game me dicloxicillin 500mg and er doc today gave me clindamycin 260mg. They are both antibiotics. He also game me some oxycodone for the pain and body aches.

heres one

Dicloxacillin
CASRN: 3116-76-5

For other data, click on the Table of Contents


Drug Levels and Effects:


Summary of Use during Lactation:
Dicloxacillin is acceptable to use during breastfeeding. Limited information indicates that single maternal doses of dicloxacillin of 250 mg produce low levels in milk that are not expected to cause adverse effects in breastfed infants. Occasionally, disruption of the infant's gastrointestinal flora, resulting in diarrhea or thrush, has been reported with penicillins, but these effects have not been adequately evaluated.


Drug Levels:
Maternal Levels. After a single oral dose of 250 mg of dicloxacillin in 2 women, milk levels ranged from 0.2 to 0.3 mg/L between 2 and 4 hours after the dose. The drug was undetectable in milk at 1 and 6 hours after the dose.[1]

Infant Levels. Relevant published information was not found as of the revision date.


Effects in Breastfed Infants:
Relevant published information was not found as of the revision date.


Possible Effects on Lactation:
Relevant published information was not found as of the revision date.


AAP Category:
Not listed, but the related penicillins amoxicillin and ticarcillin are rated as usually compatible with breastfeeding.[2]


References:
1. Matsuda S. Transfer of antibiotics into maternal milk. Biol Res Pregnancy. 1984;5:57-60. PMID: 6743732
2. American Academy of Pediatrics. Committee on Drugs. The transfer of drugs and other chemicals into human milk. Pediatrics. 2001;108:776-89. PMID: 11533352



Substance Identification:


Substance Name: Dicloxacillin

CAS Registry Number: 3116-76-5

Drug Class:
Antiinfective Agents
Penicillins

Administrative Information:


LactMed Record Number:
90


Last Revision Date:
20081121

Disclaimer: Information presented in this database is not meant as a substitute for professional judgment. You should consult your healthcare provider for breastfeeding advice related to your particular situation. The U.S. government does not warrant or assume any liability or responsibility for the accuracy or completeness of the information on this Site.

AND

Clindamycin
CASRN: 18323-44-9

For other data, click on the Table of Contents


Drug Levels and Effects:


Summary of Use during Lactation:
Clindamycin has the potential to cause adverse effects on the breastfed infant's gastrointestinal flora. If oral or intravenous clindamycin is required by a nursing mother, it is not a reason to discontinue breastfeeding, but an alternate drug may be preferred. Monitor the infant for possible effects on the gastrointestinal flora, such as diarrhea, candidiasis (thrush, diaper rash) or rarely, blood in the stool indicating possible antibiotic-associated colitis.

Vaginal application is unlikely to cause infant side effects, although about 30% of a vaginal dose is absorbed. Infant side effects are unlikely with topical administration for acne, however topical application to the nipple may increase the risk of diarrhea in the infant.


Drug Levels:
Maternal Levels. Two women were give clindamycin 150 mg orally. Breastmilk levels of clindamycin averaged 1.3 mg/L 4 hours after the dose.[1]

Two women were treated with clindamycin 600 mg intravenously every 6 hours followed by 300 mg orally every 6 hours. Peak milk levels after the intravenous dose were 2.65 mg/L at 3.5 hours after the dose in one and 3.1 mg/L at 30 minutes after the dose in the other. During the oral regimen, peak milk levels were 1.3 mg/L at 3.5 hours after the dose in the first woman and 1.8 mg/L at 2 hours after the dose in the other.[2]

Five women were given oral clindamycin 150 mg three times daily during the first 2 weeks postpartum. Milk levels were measured after at least 1 week of therapy and averaged 1.2 mg/L (range <0.5 mg/L to 3.1 mg/L) 6 hours after the dose.[3]

After a single oral dose of 150 mg of clindamycin in 2 women, milk levels averaged from 0.3 to 1.2 mg/L between 1 and 6 hours after the dose. The peak occurred at 2 hours after the dose in one woman and 4 hours after the dose in the other.[4]

After a single dose of 600 mg of clindamycin intravenously to 15 women who were 1 month postpartum, milk clindamycin levels averaged 1.03 mg/L 2 hours after the dose.[5]

In summary, the amounts in milk represent an infant dosage of about 1 to 2.5% of the maternal weight-adjusted dosage.[2][3][5]

Infant Levels. Relevant published information was not found as of the revision date.


Effects in Breastfed Infants:
Bloody stools in a 5-day-old breastfed infant were possibly caused by concurrent maternal clindamycin 600 mg intravenously every 6 hours and gentamicin 80 mg intravenously every 8 hours. The infant's stools were reported to have normal flora and the stools became guaiac negative 24 hours after discontinuation of breastfeeding. On day 6 of age, the infant resumed breastfeeding after discontinuation of maternal antibiotics with no further difficulties.[6]


Possible Effects on Lactation:
Relevant published information was not found as of the revision date.

SO they are both safe....they can cause stomach upset and mess with their intestinal flora BUT so can formula...it even says its not a reason to stop nursing

NURSE THAT BABY

[tabi_cat1023]

and

Oxycodone
CASRN: 76-42-6

For other data, click on the Table of Contents


Drug Levels and Effects:


Summary of Use during Lactation:
Maternal use of maximum dosages of oral narcotics while breastfeeding can cause infant drowsiness. Newborn infants seem to be particularly sensitive to the effects of even small dosages of narcotic analgesics, particularly in the first week of life. However, the newborn's dosage is limited by the small volumes of colostrum in the first 2 to 3 days postpartum. Once the mother's milk comes in, it is best to limit maternal intake of oral oxycodone (and combinations) and to supplement analgesia with a nonnarcotic analgesic if necessary. A maximum oxycodone dosage of 30 mg daily is suggested. Oxycodone elimination is decreased in young infants and much inter-individual variability exists. Monitor the infant for drowsiness, adequate weight gain, and developmental milestones, especially in younger, exclusively breastfed infants. If the baby shows signs of increased sleepiness (more than usual), difficulty breastfeeding, breathing difficulties, or limpness, a physician should be contacted immediately.


Drug Levels:
Oxycodone is metabolized to the active metabolites, noroxycodone and oxymorphone. In adults, oxycodone has an oral bioavailability of 60% to 87% in adults.[1] Oxycodone elimination is decreased in young infants and much inter-individual variability exists. Oxycodone can be dangerous when used as an analgesic in newborns.[2]

Maternal Levels. Six breastfeeding mothers who were using 1 to 2 capsules containing a combination of 5 mg oxycodone and 500 mg acetaminophen every 4 to 7 hours for post-cesarean section pain had their milk sampled several times after successive doses. Peak oxycodone milk levels reportedly occurred 1 to 2 hours after the first dose and then at variable times after successive doses. The number of hours after a mother's last dose when oxycodone could still be measured in milk was depended on the number of doses taken. Oxycodone could be measured in milk up to 4, 12, and 36 hours after 4, 9, and 11 doses respectively. In all the mothers, measured oxycodone milk levels ranged from undetectable (<5 mcg/L) to 229 mcg/L. The authors estimated that an exclusively breastfed infant would receive a maximum 8% of the maternal weight-adjusted dosage of oxycodone, but active metabolite levels were not measured.[3]

Fifty mothers who delivered by cesarean section and received oxycodone had milk (colostrum) and serum samples measured for oxycodone at 24, 48 and 72 hours postpartum without respect to the time of the previous oxycodone dose. The most common doses received by the mothers during the previous 24 hours (including one 30 mg dose rectally immediately post surgery in some cases) were 60 mg (range 30 to 90 mg), 40 mg (range 0 to 90 mg), and 20 mg (range 0 to 50 mg), respectively. Mean colostrum concentrations at the 3 collection times were 58 mcg/L (range 7 to 130 mcg/L), 49 mcg/L (range 0 to 168 mcg/L), and 35 mcg/L (range 0 to 31 mcg/L), respectively. Little correlation was found between maternal dosage and colostrum concentrations, although colostrum levels correlated well with maternal serum levels, with a colostrum concentrations 3.2 to 3.4 higher than serum. Ten mothers had colostrum oxycodone concentrations over 100 mcg/L and 5 had detectable oxycodone in milk 37 hours after the last dose.[4] Infant Levels. In a study of 50 mothers taking oxycodone post-cesarean section, 45 blood samples were taken from 41 breastfed infants at 24, 48 or 72 hours postpartum. Only 1 of the samples had a detectable (>2 mcg/L) oxycodone level of 7.4 mcg/L. Because these infants were in the first 3 days postpartum, their dose was probably limited by the small volumes of colostrum they were ingesting.[4]


Effects in Breastfed Infants:
A 10-month-old, 7.7 kg infant of a prescription drug-dependant mother died of cardiac arrest after a 12- to 24-hour period of lethargy, hypersomnolence and dyspnea. The infant also had a recent history of fever. The mother had reportedly been breastfeeding the infant 3 times a day for several weeks and had taken 180 mg of oxycodone, as well as muscle relaxants, the day prior to her infant's death. A blood oxycodone level of 600 mcg/L was measured on autopsy. The medical examiner considered it unlikely that such a high level of oxycodone in the infant's blood could be due to breastfeeding exposure as reported by the mother and thus considered the death a homicide resulting from either the intentional administration of oxycodone directly to the infant or from a higher dose of oxycodone in breastmilk than that reported by the mother.[5]

In a study of 50 mothers taking oxycodone post-cesarean section, 50 neonates were evaluated for sedation ever 24 hours after birth. None was severely sedated and less than 4% had sedation of 3 on a 1 to 5 scale. Because these infants were in the first 3 days postpartum, their oxycodone dose was probably limited by the small volumes of colostrum they were ingesting.[4]


Possible Effects on Lactation:
Oxycodone can increase serum prolactin.[6] However, the prolactin level in a mother with established lactation may not affect her ability to breastfeed.


AAP Category:
Not listed, but the narcotic morphine is rated as usually compatible with breastfeeding.[7]


Alternate Drugs to Consider:
Acetaminophen, Ibuprofen, Morphine


References:
1. Baselt RC. Disposition of toxic drugs and chemicals in man. 6th ed. Foster City: Biomedical Publications, 2002:787�9.
2. Pokela ML, Anttila E, Seppala T et al. Marked variation in oxycodone pharmacokinetics in infants. Paediatr Anaesth. 2005 Jul;15(7):560-5. PMID: 15960639
3. Marx CM, Pucino F, Carlson JD et al. Oxycodone excretion in human milk in the puerperium. Drug Intell Clin Pharm. 1986;20:474. Abstract.
4. Seaton S, Reeves M, McLean S. Oxycodone as a component of multimodal analgesia for lactating mothers after Caesarean section: Relationships between maternal plasma, breast milk and neonatal plasma levels. Aust N Z J Obstet Gynaecol. 2007 ;47:181-5. PMID: 17550483
5. Levine B, Moore KA, Aronica-Pollak P et al. Oxycodone intoxication in an infant: accidental or intentional exposure? J Forensic Sci. 2004;49:1358-60. PMID: 15568714
6. Saarialho-Kere U, Mattila MJ, Seppala T. Psychomotor, respiratory and neuroendocrinological effects of a mu-opioid receptor agonist (oxycodone) in healthy volunteers. Pharmacol Toxicol. 1989;65:252-7. PMID: 2555803
7. American Academy of Pediatrics. Committee on Drugs. The transfer of drugs and other chemicals into human milk. Pediatrics. 2001;108:776-89. PMID: 11533352



Substance Identification:


Substance Name: Oxycodone

CAS Registry Number: 76-42-6

Drug Class:

[tabi_cat1023]

btw oxycodone increases prolactin...which is the hormone that causes BM to be made