Maternal infectious diseases, antimicrobial therapy or immunizations: Very few contraindications to breastfeeding

Question 1

What are the breastfeeding recommendations re: mastitis and breast abscesses?

Answer 1

Continue breastfeeding unless there is obvious pus, in which case pump milk and discard from the infected breast and continue to breastfeed from the other breast

Question 2

What are the breastfeeding recommendations re: TB?

Answer 2

1. Delay direct breastfeeding until mother has received 2 weeks of appropriate anti-TB therapy
2. Feed infant EBM during 2 week period
3. Provide TB prophylaxis for infant

Question 3

Which infections can you continue breastfeeding?

Answer 3

1. UTI
2. Bacterial infection abdominal wall post c/s
3. Diarrhea
4. Other bacterial infections
5. Malaria
6. Candidal vaginitis
7. CMV
8. Enterovirus
9. Parvovirus
10. West Nile Virus

Question 4

What are infectious contraindications to breastfeeding?

Answer 4

1. Brucellosis
2. HIV
3. Human T-cell lymphotrophic virus type I or II

Question 5

What are the recommendations re: breastfeeding and hepatitis A virus?

Answer 5

Continue breastfeeding; immunoglobulin prophylaxis for the infant. Practice meticulous hand hygiene

Question 6

What are the recommendations re: breastfeeding and hepatitis B virus?

Answer 6

Continue breastfeeding; routine prevention of infant HBV infection with HBIG at birth; immunization with HBV vaccine

Question 7

What are the recommendations re: breastfeeding and hepatitis C virus?

Answer 7

Continue breastfeeding; immunization with HBV vaccine

Question 8

What are the recommendations re: breastfeeding and HSV?

Answer 8

Continue breastfeeding. Practice meticulous hand hygiene. Cover oral labial
lesions with a mask. If there are lesions on the breast/ HSV mastitis, verify that it is HSV not varicella-zoster virus. Interrupt direct breastfeeding until lesions are crusted over. Use expressed breast milk

Question 9

What are the recommendations re: breastfeeding and VZV?

Answer 9

Continue breastfeeding. For perinatal VZV, give VZIG; for postpartum, consider VZIG

Question 10

What are the recommendations re: TB medications (isoniazid, rifampin, streptomycin, ethambutol) and breastfeeding?

Answer 10

Continue breastfeeding. Infants only need pyridoxine supplementation if receiving isoniazid themselves

Question 11

What are the recommendations re: antimalarials and breastfeeding?

Answer 11

Group 1: Chloroquine, quinidine, ivermectin; maternal topical diethyltoluamide
or icaridin/picaridin: continue breastfeeding

Group 2: Primaquine, quinine: Contraindicated during breastfeeding unless both mother and baby have normal G6PD levels

Question 12

What are the recommendations regarding breastfeeding on penicillins, cephalosporins, carbapenems, aminoglycosides, and quinolones?

Answer 12

Continue breastfeeding

Question 13

What are the recommendations regarding breastfeeding on high dose metronidazole?

Answer 13

Discontinue breastfeeding for 12 h to 24 h to allow excretion of dose

Question 14

What are the recommendations regarding breastfeeding on chloramphenicol?

Answer 14

Caution: Possible idiosyncratic bone marrow suppression

Question 15

What are the recommendations regarding breastfeeding on TMP/SMX, sulfisoxazole, or dapsone?

Answer 15

Proceed with caution if nursing infant has jaundice or G6PD deficiency, and also if the child is ill, stressed or premature

Question 16

What are the recommendations regarding breastfeeding on fluconazole or ketoconazole?

Answer 16

Continue breastfeeding

Question 17

What are the recommendations regarding breastfeeding on acyclovir, valacyclovir, or amantadine?

Answer 17

Continue breastfeeding. If considering prolonged use of amantadine, observe for milk suppression, as it can suppress prolactin production

Question 18

What are the recommendations re: maternal immunization and breastfeeding?

Answer 18

Breastfeeding is not a contraindication to the administration of routine recommended vaccines to the infant or the mother. Breastfeeding during immunization can help mitigate the infant’s pain and should be encouraged