Kathy,

Get back to that mother and let her know there should not be any problem
with breastfeeding while on vancomycin.

It is the *milk* level level which is 12 mg/L, not the baby's blood level. A
protein binding means that 70% of the drug is available for excretion into
the milk.  But 70% of a low amount is still a low amount.

Look at the oral absorption--minimal.  It might change the baby's gut flora,
but formula definitely does.  Why is it okay to change the gut flora with
formula but not vancomycin.

I cannot believe that 50 people in Toronto who are supposed to be health
professionals cannot figure out that vancomycin should be acceptable for
breastfeeding.  She sure didn't ask me.  She sure didn't ask Mother Risk.
Or, more importantly, the people who told her she couldn't breastfeed,
didn't check first.

Jack Newman, MD, FRCPC