Letters to the Editor

Use of Systemic Tetracyclines in Women Who Are Lactating



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Am Fam Physician. 1998 Oct 15;58(6):1306.

to the editor: I enjoyed the excellent article on conjunctivitis written by Drs. Morrow and Abbott.1 I found it to be practical and useful. I do feel, however, that one point in the article is in error.

They write that systemic tetracyclines are contraindicated in women who are nursing. Tetracycline is excreted into breast milk in low concentrations. It binds to calcium in breast milk and is absorbed poorly by the infant. A study of lactating women who were taking 500 mg of tetracycline four times a day found that levels of tetracycline in the infants were below the level of detection (0.05 μg per mL).2,3 Theoretic concerns about the possibility of dental staining or delayed bone growth in the infants seems unlikely at these serum concentrations.3

In their publication “Transfer of Drugs and Other Chemicals into Human Milk,” the American Academy of Pediatrics places tetracycline under the label “Usually Compatible with Breast-Feeding,” the classification used for those medications that are safest in lactation.4

Better choices may be available for the treatment of meibomianitis or acne rosacea in lactating women, especially since these conditions often require prolonged treatment, but I feel it is unwise to perpetuate the misconception that tetracyclines are always contraindicated during lactation.

REFERENCES

1. Morrow GL, Abbott RL. Conjunctivitis. Am Fam Physician. 1998;57:735–46.

2. Hale TW. Medications and mothers' milk. 6th ed. Amarillo, Tex.: Pharmasoft Medical Publishing, 1997:558–9.

3. Briggs GG, Freeman RK, Yaffe SJ. Drugs in pregnancy and lactation: a reference guide to fetal and neonatal risk. 4th ed. Baltimore: Williams & Wilkins, 1994:808–13.

4. American Academy of Pediatrics Committee on Drugs: The transfer of drugs and other chemicals into human milk. Pediatrics. 1994;93:137–50.

editor's note: This letter was sent to the authors of “Conjunctivitis,” who declined to reply.

 

Send letters to Kenneth W. Lin, MD, MPH, Associate Deputy Editor for AFP Online, e-mail: afplet@aafp.org, or 11400 Tomahawk Creek Pkwy., Leawood, KS 66211-2680.

Please include your complete address, e-mail address, and telephone number. Letters should be fewer than 400 words and limited to six references, one table or figure, and three authors.

Letters submitted for publication in AFP must not be submitted to any other publication. Possible conflicts of interest must be disclosed at time of submission. Submission of a letter will be construed as granting the American Academy of Family Physicians permission to publish the letter in any of its publications in any form. The editors may edit letters to meet style and space requirements.



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