So I'm off harrassing the OB/GYN

[KUMoose]

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http://forums.studentdoctor.net/showthread.php?t=563859

I asked the practicing OB/GYNs would they (in a hypothetical world) prescribe 500mg cipro x1 to a new mother breast-feeding (any changes to the breast-feeding schedule.) So now I'm bringing it back here.

Yes, this was a PBMI (population based medical information) question and it's done and handed in, if you want to see if PM me. 😉

I asked this because I read the older literature (mostly animal studies) and a couple of small trials and one case report. Combined with Lexi-comp/company monograph (no) and Harriet Lane/AAP (ok), I'm currious what you'd do if this was dispensed and a patient asked about breast-feeding. Think of this as a rubber-meeting-road experiement when sources of information are opposed.

 

[Moxxie]

Just curious, but did you find anything about cartilage growth abnormalities in the animal studies? I have that as a contraindication for fluoroquinolones in kids under 18, but I didn't know if there was any breastfeeding data.

And what would the safest abx be for an uncomplicated UTI in a breastfeeding female?

 

[KUMoose]

I did, that's how they based their response, on the animal studies. However subsequent studies have not shown the same response in humans.

So for just a general uncomplicated UTI, the default (at least what I done lurned last year) is Bactrim or Cipro for 3 days. Bactrim is contraindicated in 3rd trimester through children less then 2mos for kernicterus, and Cipro isn't recommended, though from current studies, it does not appear to cause problems on the whole.

Given that neither appear to be great, I'd probably dose amoxicillin & ca x3-5 days and send out urine cultures just to make sure it's not some odd pos bug that's takin up residency. So I know that there are a lot of small vector UTI bugs, while amoxicillin covers a lot, it may not cover all of them (pseudomonas specifically).