Cephalexin use while Breastfeeding
Drugs containing Cephalexin: Keflex, Keftab, Zartan, Panixine, Biocef
Cephalexin Levels and Effects while Breastfeeding
Summary of Use during Lactation
Limited information indicates that maternal doses of cephalexin up to 1 gram produce low levels in milk that are usually not expected to cause adverse effects in breastfed infants. Cephalexin is an alternative for the treatment of mastitis. Occasionally disruption of the infant's gastrointestinal flora, resulting in diarrhea or thrush have been reported with cephalosporins, but these effects have not been adequately evaluated.
Maternal Levels. After a single 1 gram oral dose of cephalexin in 6 women who were 2 days postpartum, peak milk levels occurred 4 to 5 hours after the dose and averaged 0.51 mg/L (range 0.24 to 0.85 mg/L).
After a single 500 mg oral dose of cephalexin in 2 women (time postpartum not stated), peak milk levels of 0.7 mg/L occurred 4 hours after the dose.
A woman who was 28 days postpartum had been taking oral cephalexin 500 mg plus probenecid 500 mg 4 times daily for 16 days collected 12 fore-and hindmilk samples over a 16-hour period. Milk cephalexin levels ranged from about 0.4 to 1 mg/L over the milk collection period with little correlation to the times of the doses. The authors calculated that an exclusively breastfed infant would receive 112 mcg/kg daily which is much less than the recommended infant dosage of 25 to 100 mg/kg daily. The infant dosage in milk corresponds to about 0.5% of the maternal weight-adjusted dosage which is higher than in previous reports. The higher milk levels in this patient may have been a result of the concurrent probenecid use.
Infant Levels. Relevant published information was not found as of the revision date.
Effects in Breastfed Infants
In a prospective follow-up study, 7 nursing mothers reported taking cephalexin (dosage not specified). Two mothers reported diarrhea in their infants. No rashes or candidiasis were reported among the exposed infants.
A prospective, controlled study asked mothers who called an information service about adverse reactions experience by their breastfed infants. One of 11 cephalexin-exposed infants reportedly developed diarrhea during maternal cephalexin therapy.
A woman received intravenous cephalothin 1 g every 6 hours for 3 days. Her breastfed infant had a green liquid stool, severe diarrhea, discomfort and crying. The mother's drug regimen was then changed to oral cephalexin 500 mg plus oral probenecid 500 mg 4 times daily for another 16 days. The infant continued to have diarrhea during this time. The authors rated the diarrhea as probably related to cephalexin in milk.
Effects on Lactation and Breastmilk
Relevant published information was not found as of the revision date.
Alternate Drugs to Consider
1. Amir LH. ABM clinical protocol #4: Mastitis, revised March 2014. Breastfeed Med. 2014;9: 239-43. PMID: 24911394
2. Berens PD. Breast pain: Engorgement, nipple pain, and mastitis. Clin Obstet Gynecol. 2016;58:902-14. PMID: 26512442
3. Kafetzis DA, Siafas CA, Georgakopoulos PA et al. Passage of cephalosporins and amoxicillin into the breast milk. Acta Paediatr Scand. 1981;70:285-8. PMID: 7246123
4. Matsuda S. Transfer of antibiotics into maternal milk. Biol Res Pregnancy. 1984;5:57-60. PMID: 6743732
5. Ilett KF, Hackett LP, Ingle B et al. Transfer of probenecid and cephalexin into breast milk. Ann Pharmacother. 2006;40:986-9. PMID: 16551765
6. Ito S, Blajchman A, Stephenson M et al. Prospective follow-up of adverse reactions in breast-fed infants exposed to maternal medication. Am J Obstet Gynecol. 1993;168:1393-9. PMID: 8498418
7. Benyamini L, Merlob P, Stahl B et al. The safety of amoxicillin/clavulanic acid and cefuroxime during lactation. Ther Drug Monit. 2005;27:499-502. PMID: 16044108
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