I do not know why the mother cannot breastfeed while taking
Azythromycin.  It has low oral bioavailability (37%) which is decreased
when taken with food, which the baby obviously is.  Furthermore, after a
dose of 500 mg, the maximum serum concentration is 0.4 micrograms/ml.  I
do not have information about the milk:plasm ratio, but I would guess it
is not higher than 1.

        Other antibiotics which this mother could take are clindamycin and
ciproflaxin.  Though ciproflaxin is generally thought to be
contraindicated during breastfeeding, the articular damage story does
not seem to have panned out, and that was the main reason there was
concern.  There are few if any antibiotics which are incompatible with
breastfeeding.  Do not the mothers not get to make an informed choice,
even if there is some concern about the antibiotic (or any drug for that
matter?).

        When mothers get recurrent mastitis, hard on the heels of a previous
mastitis, without complete resolution, think breast abscess, which would
present with a tender mass in the breast.  The diagnosis is made by
aspiration of the mass.  Treatment is by incision and drainage, and
breastfeeding does not have to stop.

        The mother undoubtedly has a yeast component to her problems.

Hope this helps.

Jack Newman, MD, FRCPC