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    Are Norfloxacin, Speroxate and Disodium Hydrogen Citrate safe while breastfeeding?

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Posted on Mon, 31 Jul 2017 in General Health
Question: My wife has delivered a baby on 3rd May 2017. It was a normal vaginal delivery after heavy blood bleeding was there due to cervical (left lateral vaginal wall tear) issue and it was treated, controlled and discharged in 3 days. Normal bleeding was there for 4 weeks and stopped.

Now today on 10 July, 2017 (After 2 Months 7 days)
She is facing bleeding issue small quantities while passing urine with bearable pain.
We consulted the doctor and said it is urine infection.(without test reports)

Medicines:
1. Norflox-400
2. Speroxate
3. Disodium Hydrogen Citrate syrup

My Question:
Is it safe to take these medicines during breast feeding ?
What might be the reasons for bleeding ?
doctor
Answered by Dr. Bonnie Berger-Durnbaugh 44 minutes later
Brief Answer:
Information

Detailed Answer:
Hello and welcome,

I personally am hesitant to prescribe antibiotics for a UTI without first getting a urine specimen for urinalysis, and Culture and Sensitivity testing.

My reasons for this are:
1. Sometimes it is not a UTI.
2. If it is a UTI, it is important to get a sensitivity test, because of drug resistance. This is useful because if the right antibiotic is not given, and a patient's bladder infection moves up to the kidneys, we won't have information on what needs to be given to treat it.

A culture and sensitivity test means:
Culture: whatever bacteria is growing in the urine specimen is cultured and identified.
Sensitivity: different classes of commonly prescribed antibiotics are used against the cultured bacteria to see if they will kill the bacteria on the culture plates in the lab. The doctor then gets a report that states that particular antibiotics (and their general class) are "Sensitive" "Resistant" or "Mixed/Intermediate/Partially Resistant".

A "dip" urinalyisis can be done immediately in the office by the doctor's nurse which will give information as to whether this is a UTI (presence of leukocyte esterace). If it is, then an antibiotic will be given empirically, and the urine specimen should be sent for the culture and sensitivity which takes 2-3 days.

Causes of bleeding include:
-a uti (bacteria inflames and irritates the walls of the bladder causing some bleeding)
-urinary tract stones
-other causes of irritation in the urinary tract
-bleeding that isn't actually from the bladder but is from the vagina and is passed during urination

Now about whether norfloxacin is safe in breast feeding - it is considered "probably safe". Here is information from literature for physicians:

"Fluoroquinolones such as norfloxacin have traditionally not been used in infants because of concern about adverse effects on the infants' developing joints. However, recent studies indicate little risk.[1][2] In addition, the calcium in milk might prevent absorption of the small amounts of fluoroquinolones in milk,[3] but insufficient data exist to prove or disprove this assertion. The serum and milk levels and oral bioavailability of norfloxacin are the lowest of any of the fluoroquniolones, so the risk to the infant should be minimal. Use of norfloxacin is acceptable in nursing mothers with monitoring of the infant for possible effects on the gastrointestinal flora, such as diarrhea or candidiasis (thrush, diaper rash).

Drug Levels
Maternal Levels. Norfloxacin was undetectable in milk at any time up to 6 hours after a single 200 mg oral dose.[4] Milk levels have not been measured after repeated administration.

Regarding the Speroxate (which is flavoxate, a bladder muscle antispasmodic), I could not find data on safety in breastfeeding.

Infant Levels. Relevant published information was not found as of the revision date.

Effects in Breastfed Infants
Relevant published information was not found as of the revision date."

Effects on Lactation and Breastmilk
Relevant published information was not found as of the revision date.

Regarding the Speroxate (which is a bladder muscle antispasmodic) is safe during breast feeding, I could not find definitive information.

The Citrate syrup is an acid-base buffering solution. Again, I couldn't find information that details any studies on this in breastfeeding.

So what I recommend is the following:
1. Get a dip urinalysis and if there is positive leukocyte esterase, the urine specimen should be sent for a culture and sensitivity.
2. If the dip urinalysis is pos. for leukocyte esterase, an antibiotic should be started, and norfloxacin is on the "generally considered safe" list.
3. If the dip urinalysis shows blood but no neg. for leukocyte esterase, an exam should be performed to check for bleeding from the vagina, or other causes of urinary tract bleeding (such as stones).

I hope this information helps.




Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
Answered by
Dr.
Dr. Bonnie Berger-Durnbaugh

General & Family Physician

Practicing since :1991

Answered : 3136 Questions

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