lactation and cellulitis

[rxjc]

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Patient is lactating and is diagnosed with cellulitis. She is also allergic to pcn. What antibiotics can you recommend?

 

[storyhill]

ancef or vanco depending on severity of allergy and infection

 

[Praziquantel86]

Depends on the type of cellulitis and type of allergy. More info please.

 

[BidingMyTime]

I would recommend Bactrim, safe for breastfeeding and will work for many kinds of common cellulitis (assuming no susceptibility studies have been done, or the question wouldn't have to be asked.)

 

[cycloketocaine]

I would recommend Bactrim, safe for breastfeeding and will work for many kinds of common cellulitis (assuming no susceptibility studies have been done, or the question wouldn't have to be asked.)

We don't give Bactrim to breastfeeding moms because of the risk of kernicterus.

 

[BidingMyTime]

We don't give Bactrim to breastfeeding moms because of the risk of kernicterus.

It's on the AAP list of "medications compatible with breastfeeding." I'd assume the risk of kernicterus is dependent on the age of the infant.

 

[cycloketocaine]

It's on the AAP list of "medications compatible with breastfeeding." I'd assume the risk of kernicterus is dependent on the age of the infant.

Obviously. It is on the compatible list, but it is dangerous to give in a mother of a neonate. We won't dispense it to moms of our NICU babies or moms in the birthing unit (unless they are not breastfeeding).

 

[BidingMyTime]

So, we need more information. I guess my thinking was this was someone presenting to the ER, or family doctor, a mom of an older baby or even toddler--not a mother who had just given birth. The OP was a bit ambiguous, but if the patient had just given birth, that is a rather important piece to leave out, since then there they'd be the possibility of it being a hospital acquired infection. But for a non-neonate breastfeeding mother presenting from the general community to the ER (or primary physician), I still vote for Bactrim as being the drug of choice.

 

[njac]

Where is the cellulitis?

I'm inclined for keflex, if bebe isn't tiny add bactrim if concerned about mrsa. Or clinda.

 

[rph3664]

If the mother needs inpatient treatment, or can use home infusion, I'd recommend vancomycin. The molecule is too big to pass into breast milk.

 

[Praziquantel86]

If the mother needs inpatient treatment, or can use home infusion, I'd recommend vancomycin. The molecule is too big to pass into breast milk.

You'd give a breastfeeding mother with an unknown allergy to penicillin a PICC line and home health for a cellulitis that we don't know anything about?

 

[cycloketocaine]

You'd give a breastfeeding mother with an unknown allergy to penicillin a PICC line and home health for a cellulitis that we don't know anything about?

I think we should give her some Zoquin-V outpatient for 4-6 weeks.

(Zosyn + Levaquin + Vanc, a resident fave at my institution)

 

[npage148]

Bactrim, and pump and dump depending on the age of the baby. It's silly to start IV vanco just do they can continue to breast feed. Going to the infusion clinic daily is a waste of
Resources for something that can be treated without.

Edit: Praz beat me to it.

 

[Praziquantel86]

I think we should give her some Zoquin-V outpatient for 4-6 weeks.

(Zosyn + Levaquin + Vanc, a resident fave at my institution)

But the PCN allergy! And the baby is definitely going to rupture his/her Achilles from that Levaquin. Let's switch it to cefepime/amikacin, and then I'm sold. And make sure the cefepime is no more than 1g q24h.

 

[confettiflyer]

And the baby is definitely going to rupture his/her Achilles from that Levaquin.

So.... The baby's a dog?

 

[cycloketocaine]

So.... The baby's a dog?

Damn beagle puppies ruined it for everyone.

 

[pharm B]

So.... The baby's a dog?

Damn beagle puppies ruined it for everyone.

 

[rph3664]

I was coming from the angle of a woman whose infection was severe enough to warrant admission.

 

[rxjc]

Sorry for the late reply. The doctor didn't specify what kind of pcn allergy it was. I called a labor and delivery md for advise and the md said doxy one time dose was fine. And yes, this was a ER patient and was going to be discharged.

 

[njac]

Why bother if you're only giving a one time dose?