Table D-1
Precautions and Breastfeeding Recommendations for Selected Maternal Infections *
| Organism, Syndrome, or Condition † , ‡ | Empiric Precautions § | Breastfeeding Acceptable ¶ | Compatibility of Medications with Breastfeeding || |
|---|---|---|---|
| Adenoviruses | |||
| Conjunctivitis | Contact | ||
| Upper/lower respiratory infections | Droplet | Yes # | |
| Gastroenteritis | Standard | ||
| Amebiasis | |||
| Entamoeha histolytica | |||
| Intestinal | Standard | Yes | Iodoquinol, paromomycin, metronidazole, tinidazole |
| Extraintestinal | Standard | Yes | |
| Anthrax | |||
| Bacillus anthracis (cutaneous, inhalation, gastrointestinal) | Standard, add contact precautions for draining cutaneous lesions | Yes, if cutaneous lesion is not on the breast and can be covered | Ciprofloxacin |
| Arboviruses | |||
| Arthropod-borne infections, meningoencephalitis, hemorrhagic fevers, hepatitis | Standard | Yes ** | |
| California encephalitis | Standard | Yes | |
| Colorado tick fever | Standard | Yes | |
| Dengue fever | Standard | Yes | |
| Eastern equine encephalitis | Standard | Yes | |
| Japanese encephalitis | Standard | Yes | |
| St. Louis encephalitis | Standard | Yes | |
| West Nile virus | Standard | Yes ** | |
| Yellow fever | Standard | Yes | |
| Yellow fever vaccine virus | Standard | No ** | |
| Arcanobacterium haemolyticus | |||
| Pharyngitis, skin infections | Standard | Yes | Erythromycin, azithromycin clindamycin, cefuroxime, tetracycline |
| Ascaris lumbricoides | |||
| Gastrointestinal infections, pneumonitis | Standard | Yes | Pyrantel pamoate, mebendazole, albendazole, piperazine |
| Aspergillosis | |||
| Bronchopulmonary, sinus, or invasive infections | Standard | Yes | Amphotericin B, flucytosine, rifampin |
| Astroviruses | |||
| Gastroenteritis | Standard, but contact for incontinent individuals | Yes | |
| Babesiosis | |||
| Babesia microti | |||
| Subacute/chronic febrile illness | Standard | Yes | Clindamycin + quinine, atovaquone + azithromycin |
| Blastocystis hominis | |||
| Gastrointestinal infection | Standard | Yes | Metronidazole, nitazoxanide, trimethoprim-sulfamethoxazole (TMP-SMX) |
| Blastomycosis | |||
| Blastomyces dermatitidis | |||
| Pulmonary, cutaneous, or invasive infection | Standard | Yes | Amphotericin B, fluconazole, itraconazole |
| Borrelia | |||
| Relapsing fever | |||
| Borrelia hermsii | Standard (tick-borne) | Yes | Penicillin, erythromycin, tetracycline |
| Borrelia recurrentis | Contact (louse-borne) | Yes | |
| Borrelia turicatae | Standard (tick-borne) | Yes | Doxycycline |
| Botulism | |||
| Clostridium botulinum | |||
| Hypotonia, progressive weakness, toxin-mediated paralysis | Standard | Yes | |
| Breast abscess (see Mastitis) | |||
| Staphylococcus aureus Enterobacteriaceae Streptococcus pyogenes | Contact (24 h) | Yes (after 24 h if no drainage into breast milk; discard breast milk for first 24 h after surgery) | First-generation cephalosporin, amoxicillin/clavulanate, ampicillin/sulbactam |
| Brucellosis | |||
| Febrile illness with variable manifestations | Standard | Yes (after 48 h of therapy in mother; discard breast milk for 48 h) | Doxycycline, TMP-SMX, rifampin, gentamicin, streptomycin, tetracycline |
| Brucella abortus Brucella melitensis Brucella suis | Contact (for draining wounds) | Yes | |
| Calciviruses | |||
| Gastroenteritis | Standard, but contact for incontinent individuals | Yes | |
| Campylobacter | |||
| Gastrointestinal infection Campylobacter fetus Campylobacter jejuni | Standard, but contact for incontinent individuals | Yes | Erythromycin, azithromycin, ciprofloxacin |
| Candidiasis | |||
| Mucocutaneous infection, vulvovaginitis, invasive infections Candida albicans Candida krusei Candida tropicalis | Standard | Yes (therapy for the infant simultaneous with mother’s therapy) ** | Topical agents, fluconazole, ketoconazole, itraconazole, amphotericin B, flucytosine |
| Cat-scratch disease | |||
| Skin infection, regional lymphadenitis, and rarely, invasive infection Bartonella henselae | Standard | Yes | Azithromycin, TMP-SMX, rifampin, ciprofloxacin, gentamicin, doxycycline, erythromycin |
| Chlamydia | |||
| Chlamydophila pneumonia | Standard | Yes | Tetracycline, doxycycline, erythromycin, azithromycin |
| Pharyngitis, pneumonia | |||
| Chlamydophila psittaci Psittacosis, pneumonia, rarely invasive infection | Standard | Yes | Tetracycline, doxycycline, erythromycin, azithromycin, |
| Chlamydia trachomatis Urethritis, vaginitis, endometritis, salpingitis, lymphogranuloma venereum, conjunctivitis, pneumonia | Standard | Yes (consider treating the infant simultaneously) | Erythromycin, azithromycin, doxycycline, sulfonamide, levofloxacin, ofloxacin |
| Clostridia | |||
| Clostridium botulinum | |||
| Toxin-mediated paralysis | Standard | Yes | Antibiotic therapy not indicated |
| Clostridium difficile | |||
| Antimicrobial-associated diarrhea, pseudomembranous colitis | Contact | Yes | Metronidazole, vancomycin, fidaxomicin |
| Clostridium perfringens | |||
| Food poisoning, wound infection, gas gangrene, myonecrosis | Standard | Yes | |
| Coccidioides immitis | |||
| Pulmonary, invasive infections rarely, extrapulmonary | Standard, but contact for draining lesions | Yes | Amphotericin B, fluconazole, itraconazole |
| Conjunctivitis | |||
| Adenovirus | Contact | Yes | |
| Chlamydia trachomatis | Standard | Yes | Tetracycline, doxycycline, erythromycin |
| Neisseria gonorrhoeae | Standard | Yes †† | Penicillin, ceftriaxone |
| Cryptococcus neoformans | |||
| Meningitis, pneumonia | Standard | Yes | Amphotericin B, flucytosine, fluconazole |
| Cryptosporidiosis | |||
| Cryptosporidium parvum | |||
| Diarrhea | Contact | Yes | Nitazoxanide, paromomycin, azithromycin |
| Cytomegalovirus (CMV) | |||
| Asymptomatic infection | Standard | Yes (for full-term infants) | |
| Infectious mononucleosis | Standard | No (for premature or immunodeficient infants, do not give expressed breast milk) ** | |
| Dengue fever | |||
| Acute febrile illness, hemorrhagic fever | Standard | Yes | |
| Diphtheria | |||
| Corynebacterium diphtheriae | |||
| Membranous nasopharyngitis Obstructive laryngotracheitis Cutaneous infection, toxin-mediated myocarditis, or neurologic disease | Droplet (DI) Droplet (DI) Contact (cover lesions) | Yes (with infant receiving chemoprophylaxis-P) No (only if skin lesion involves breast) | Erythromycin, penicillin |
| Diarrhea | |||
| Campylobacter fetus | Standard | Yes | Azithromycin |
| Campylobacter jejuni | Standard + Contact for infants | Yes | Erythromycin, ciprofloxacin |
| Escherichia coli (O157:H7) | Contact | Yes | None indicated |
| Giardia lamblia | Standard | Yes | Metronidazole, tinidazole, nitazoxanide |
| Rotavirus | Contact | Yes | |
| Salmonella enteritidis | Standard | Yes | |
| Shigella boydii | Contact | Yes | Ciprofloxacin, ceftriaxone, TMP-SMX |
| Shigella dysenteriae | Contact | Yes | Ciprofloxacin, ceftriaxone, TMP-SMX |
| Shigella flexneri | Contact | Yes | Ciprofloxacin, ceftriaxone, TMP-SMX |
| Shigella sonnei | Contact | Yes | Ciprofloxacin, ceftriaxone, TMP-SMX |
| Vibrio cholerae | Standard | Yes | Doxycycline, azithromycin, tetracycline, ciprofloxacin, furazolidone |
| Vibrio parahaemolyticus | Standard | Yes | None |
| Yersinia enterocolitica | Standard + Contact for incontinent persons | Yes | For sepsis or invasive disease—ciprofloxacin, norfloxacin, ceftriaxone, TMP-SMX, doxycycline |
| Yersinia pseudotuberculosis | Standard | Yes | |
| Ebola virus | Contact, droplet, and airborne | No (do not give expressed breast milk) | |
| Encephalitis | |||
| Enteroviruses | Standard | Yes | |
| Lyme disease (Borrelia burgdorferi) | Standard | Yes | Ceftriaxone, doxycycline, amoxicillin |
| Rabies | Standard | No (BM +) | Rabies immune globulin, rabies vaccine |
| Endometritis, pelvic inflammatory disease | |||
| Anaerobic organisms | Standard | Yes | Clindamycin, metronidazole, cefoxitin, cefmetazole |
| Chlamydia trachomatis | Standard | Yes | Erythromycin, azithromycin, tetracycline, levofloxacin |
| Enterobacteriaceae | Standard | Yes | Ampicillin, aminoglycosides, cephalosporins |
| Group B streptococci | Standard | Yes ** (after 24 h of therapy for mother, breast milk is permissible with observation of infant) No ** (if infant is sick with suspected or proven group B streptococcal infection and the breast milk is being cultured to identify a source of infection; permissible if breast milk is culture negative) | Penicillin, cephalosporin, macrolides |
| Mycoplasma hominis | Standard | Yes | Clindamycin, tetracycline |
| Neisseria gonorrhoeae | Standard | Yes †† | Ceftriaxone, spectinomycin, doxycycline, azithromycin |
| Ureaplasma urealyticum | Standard | Yes | Erythromycin, azithromycin, clarithromycin, tetracycline |
| Enteroviruses | |||
| Myocarditis: respiratory, gastrointestinal, skin, central nervous system, and eye infections | Adults: standard Children: contact | ||
| Coxsackievirus | Yes | ||
| Echovirus | Yes | ||
| Polioviruses | Yes | ||
| Epstein-Barr virus | |||
| Infectious mononucleosis, broad range of infections | Standard | Yes | |
| Erythema infectiosum | |||
| Parvovirus B19 | Standard | Yes (no infectious risk after the appearance of the rash in immune-competent individuals) | |
| Food poisoning | |||
| Bacillus cereus | |||
| Toxin mediated | Standard | Yes | |
| Clostridium perfringens | |||
| Toxin mediated | Standard | Yes | |
| Escherichia coli (O157:H7) | Contact | Yes | |
| Enterohemorrhagic | |||
| Hepatitis A | Standard | Yes (immune serum globulin and hepatitis A vaccine for the infant) | |
| Norwalk virus | Standard | Yes | |
| Salmonella enteritidis | Standard | Yes | |
| Shigella | Contact | Yes | Ciprofloxacin, TMP-SMX |
| Staphylococcus aureus | |||
| Enterotoxin | Standard | Yes | |
| Gastroenteritis (see Diarrhea or Food Poisoning) | |||
| Giardiasis | |||
| Giardia lamblia | Standard, no contact with incontinent individuals | Yes | Metronidazole, tinidazole, nitazoxanide |
| Gonorrhea | |||
| Genital, pharyngeal, conjunctival, or disseminated infection | |||
| Neisseria gonorrhoeae | Standard | Yes †† | Ceftriaxone, azithromycin, erythromycin, doxycycline |
| Haemophilus influenzae | |||
| Meningitis, epiglottitis, pneumonia, cellulitis, sinusitis, bacteremia | Droplet | Yes (24 h after initiating therapy in mother; breast milk † ; P ** if infant has not been fully immunized, observation) | Cefotaxime, ceftriaxone, ampicillin |
| Hantavirus | |||
| Pulmonary syndrome, hemorrhagic fever with renal syndrome | Standard | Yes | Intravenous ribavirin is investigational |
| Hemorrhagic fevers | |||
| African hemorrhagic fever | |||
| Ebola virus | Contact | No (no expressed breast milk) | |
| Marburg virus | Contact | No (no expressed breast milk) | |
| Dengue virus (1–4) | Standard | Yes (breast milk +) | |
| Hantavirus | Standard | Yes (breast milk +) | |
| Lassa fever | Contact | No (no expressed breast milk) | Intravenous ribavirin? |
| Yellow fever | Standard | Yes ** (breast milk +) | Vaccine |
| Yellow fever vaccine virus immunization in mother ** | Standard | No ** | |
| Hepatitis ** | |||
| A Acute only | Standard, but contact for incontinent individuals | Yes (after immune serum globulin [ISG] and vaccine) | |
| B Chronic hepatitis, cirrhosis, hepatocellular carcinoma | Standard | Yes (after hepatitis B immunoglobulin [HBIG] and vaccine) | |
| C Chronic hepatitis, cirrhosis, hepatocellular carcinoma | Standard | Yes | |
| D Associated with hepatitis B | Standard | Yes (after HBIG and vaccine) | |
| E Severe disease in pregnant women | Standard | Yes | |
| G | Standard | Inadequate data | |
| Herpesviruses | |||
| Cytomegalovirus (CMV) | Standard | Yes for full-term infants | Ganciclovir, valganciclovir, foscarnet |
| Asymptomatic, infectious mononucleosis-like syndrome: severe disease in the immunodeficient person | No for premature or immunodeficient infants (infant of CMV-negative mother should not receive milk from CMV-positive mothers) | ||
| Epstein-Barr virus | |||
| Asymptomatic, infectious mononucleosis, associated with chronic fatigue syndrome, African Burkitt lymphoma, and nasopharyngeal carcinoma | Standard | Yes | |
| Herpes simplex | |||
| Types 1, 2 (HSV 1,2 ) | |||
| Mucocutaneous | Contact | Yes (in the absence of breast lesions) | Acyclovir, valacyclovir, famciclovir |
| Neonatal | Contact | ||
| Encephalitis | Standard | ||
| Varicella-zoster virus ** | |||
| Varicella | Airborne | No (Breast milk + is permissible in absence of lesions on the breast). Give VariZIG for the exposed infant. | Acyclovir, valacyclovir, famciclovir |
| Zoster | Standard in normal patient | ||
| Airborne/contact in immunocompromised individuals | No, VariZIG for the exposed infant, especially less than 1 month of age ** | ||
| Human herpesvirus 6 (HHV-6) | |||
| Roseola (exanthema subitum, sixth disease), acute febrile illness | Standard | Yes | |
| Histoplasmosis | |||
| Acute pulmonary disease, disseminated | Standard | Yes | Amphotericin B, itraconazole, fluconazole |
| Human immunodeficiency viruses (HIV) ** | |||
| HIV-1 | Standard | Yes/no ** | Limited information on antiretrovirals in breast milk ** Antiretroviral medications for the mother and/or infant through period of lactation |
| HIV-2 | Standard | Yes/no ** | |
| Human T-cell leukemia viruses (HTLV) | |||
| HTLV-1 | |||
| T-cell leukemia/lymphoma, myelopathy, dermatitis, adenitis, Sjögren’s syndrome | Standard | No ** | |
| HTLV-II | |||
| Myelopathy, arthritis, glomerulonephritis | Standard | No ** | |
| Impetigo | Contact | Yes | Oxacillin, dicloxacillin, erythromycin, first-generation cephalosporins |
| Infectious mononucleosis (see CMV, EBV) | |||
| Influenza | Droplet | Yes | Osetamavir, zanamivire, amantadine, rimantadine |
| Junin virus | |||
| Argentine hemorrhagic fever | Contact | No (do not give expressed breast milk) | |
| Lassa fever | Contact | No (do not give expressed breast milk) | Intravenous ribavirin |
| Legionnaires’ disease | |||
| Legionella pneumophila | Standard | Yes | Azithromycin, erythromycin, levofloxacin |
| Pneumonia ± gastrointestinal, central nervous system, or renal involvement | |||
| Leprosy | |||
| Mycobacterium leprae | Standard | Yes | Dapsone, rifampin, clofazimine |
| Chronic disease of skin, peripheral nerves, and respiratory mucosa | |||
| Leptospirosis | |||
| Abrupt febrile illness, often biphasic, with multiple organ involvement | |||
| Leptospira interrogans | Standard | Yes (no mother-infant contact except for breastfeeding) | Penicillin, cefotaxime, ceftriaxone |
| Leptospira icterohaemorrhagiae | |||
| Leptospira canicola | |||
| Listeria monocytogenes | |||
| In adults: Nonspecific febrile illness; in neonates: meningitis, pneumonia, sepsis, granulomatosis infantisepticum | Standard | Yes | Ampicillin, penicillin, TMP-SMX |
| Lyme disease | |||
| Borrelia burgdorferi | |||
| Multistaged illness of skin, joint, and peripheral or central nervous system | Standard | Yes, with informed discussion ** | Ceftriaxone, ampicillin, doxycycline |
| Lymphocytic choriomeningitis | |||
| Aseptic meningitis to severe encephalitis, with variable presentation of other symptoms | Standard | Yes | |
| Malaria | Standard | Yes | Pyrimethamine-sulfadoxine, chloroquine, quinidine, quinine, tetracycline, mefloquine |
| Marburg virus | |||
| Hemorrhagic fever | Contact | No (no expressed breast milk) | |
| Mastitis | |||
| Candida albicans | Standard | Yes, with simultaneous treatment of the infant ** | Nystatin, ketoconazole, fluconazole |
| Enterobacteriaceae | Standard | Yes | First-generation cephalosporin, |
| Staphylococcus aureus | Contact | Yes ** (after 24 h of therapy, during which milk must be discarded) (If infant becomes ill during evaluation and treatment of mother, infant should be treated for presumed staphylococcal infection, and breast milk should be withheld until proven to be culture negative.) | Dicloxacillin, oxacillin, erythromycin |
| Group A streptococcus | Contact | Yes ** (after 24 h of therapy, during which milk must be discarded) (If infant becomes ill during evaluation and treatment of mother, infant should be treated for presumed streptococcal infection, and breast milk should be withheld until proven to be culturally negative.) | Ampicillin, third-generation cephalosporin |
| Mycobacterium tuberculosis | Standard (if mother has pulmonary involvement, then airborne precautions as well) | No ** (breastfeeding for 2 weeks of maternal therapy, consider prophylactic INH for infant [see Figures 16-1 and 16-2 ], breast milk permissible with INH) | Isoniazid, rifampin, ethambutol, pyrazinamide ethionamide |
| Measles | |||
| Febrile illness with coryza, conjunctivitis, cough, and an erythematous maculopapular rash | Airborne | Yes (after 72 h of rash in mother and after infant receives ISG, expressed breast milk is permissible) | Ribavirin is experimental |
| Meningitis | |||
| Aseptic meningitis (nonbacterial, viral meningitis) | Standard | Yes | |
| Fungal meningitis | Standard | Yes | Amphotericin, itraconazole, flucytosine |
| Haemophilus influenzae | Droplet (for first 24 h of appropriate therapy and carrier eradication with ceftriaxone or rifampin) | Yes (after 24 h of maternal therapy, with the infant receiving prophylaxis, P; begin infant vaccination; expressed breast milk is permissible) | Ceftriaxone, ampicillin, chloramphenicol, rifampin |
| Neisseria meningitidis | Droplet (24 h of appropriate therapy and carrier eradication with ceftriaxone or rifampin) | Yes (after 24 h of maternal therapy, with the infant receiving prophylaxis, P; expressed breast milk is permissible) | Ceftriaxone, penicillin, chloramphenicol |
| Streptococcal pneumoniae | Standard | Yes | Ceftriaxone, penicillin, vancomycin |
| Mumps | Droplet | Yes | |
| Mycobacterium tuberculosis ** | Standard and airborne | Yes | Antituberculosis medications are acceptable during breastfeeding (see Chapter 13 , section on Tuberculosis and ** Red Book , 30th Edition) |
| Mycoplasma pneumoniae | |||
| Bronchitis, pneumonia, pharyngitis, otitis media, and a broad range of unusual manifestations, including central nervous system, cardiac, skin, muscle, and joint involvement | Droplet | Yes | Erythromycin, clarithromycin, azithromycin, tetracycline |
| Neisseria meningitidis | |||
| Meningitis, meningococcemia | Droplet (for 24 h of appropriate therapy and carrier eradication with ceftriaxone or rifampin) | Yes (after 24 h of appropriate therapy, and with prophylaxis for the infant) | Penicillin, ceftriaxone, chloramphenicol, rifampin |
| Norwalk agent | |||
| Gastroenteritis | Standard | Yes | |
| Papillomaviruses | |||
| Skin or mucous membrane warts, laryngeal papillomas | Standard | Yes (in the absence of breast involvement) | |
| Parainfluenza viruses | |||
| Laryngotracheobronchitis, upper and lower respiratory infections | Standard (contact for infants and children) | Yes | |
| Parvovirus B19 | |||
| Erythema infectiosum, fifth disease, aplastic crisis, arthritis | Standard Droplet for mothers with aplastic crisis or immunodeficient and prolonged illness | Yes (no infectious risk after the appearance of the rash in immune-competent individuals) No (for aplastic crisis or infection in individuals with hemoglobinopathy or immune deficiency infection for the duration of the illness [DI]) § | |
| Pelvic inflammatory disease (see Endometritis) | |||
| Pertussis | |||
| Whooping cough, pneumonia, bronchitis, encephalitis | |||
| Bordetella parapertussis and Bordetella pertussis | Droplet (for 5 days of appropriate therapy) | Yes (after 5 days of appropriate therapy and chemoprophylaxis for the infant, expressed breast milk is permissible) If no appropriate Rx is given then 3 weeks of droplet precautions | Erythromycin, clarithromycin, TMP-SMX |
| Pneumocystis jiroveci pneumonia (previously Pneumocystis carinii pneumonitis) | Standard | Yes, but suspect HIV infection if mother develops symptoms and reassess breastfeeding with HIV infection in mind | Pentamidine, TMP-SMX, atovaquone,prednisone |
| Pneumonia (see specific causative agents) | |||
| Poliomyelitis | Standard | Yes | |
| Rabies | |||
| Severe, progressive central nervous system infection, generally fatal | Standard | No ** (when mother is clinically sick) Yes ** (BM +) (during postexposure immunization of mother without symptoms; yes if both mother and infant are receiving postexposure immunization) | Rabies immune globulin, rabies vaccine |
| Rat-bite fever | |||
| Spirillum minus | Standard | Yes | Tetracycline, chloramphenicol, streptomycin |
| Streptobacillus moniliformis | Standard | Yes | Penicillin |
| Relapsing fever | |||
| Borrelia recurrentis | Standard (tick-borne) | Yes | Tetracycline, doxycycline, TMP-SMX, streptomycin, rifampin |
| Contact if louse infested | Yes with simultaneous treatment of mother and infant for lice | ||
| Respiratory syncytial virus | |||
| Upper respiratory infection, pneumonia, bronchiolitis | Contact | Yes | Ribavirin |
| Retroviruses | |||
| (see Human immunodeficiency viruses 1, 2 and Human T-cell leukemia viruses I, II) | |||
| Rickettsial diseases | |||
| Fever, rash, vasculitis;arthropod, louse-borne | |||
| Ehrlichiosis, leukopenia | Standard | Yes | Doxycycline, tetracycline |
| Ehrlichia chaffeensis | |||
| Q fever | |||
| Coxiella burnetii | |||
| Pneumonia, hepatosplenomegaly, endocarditis | Standard | Yes | Doxycycline, tetracycline, TMP-SMX |
| Rickettsial pox | |||
| Rickettsia akari | |||
| Scab or eschar, rash, regional lymphadenopathy, self-limited | Standard | Yes | Doxycycline, tetracycline, fluoroquinolones |
| Rocky Mountain spotted fever | |||
| Rickettsia rickettsii | Standard | Yes | Doxycycline |
| Typhus (flea-borne) | |||
| Rickettsia typhi | Standard | Yes | Doxycycline, fluoroquinolones |
| Typhus (louse-borne) | |||
| Rickettsia prowazekii | Standard | Yes | Doxycycline (in epidemic situations a single dose may be adequate), chloramphenicol |
| Rotavirus | |||
| Diarrhea, vomiting, “winter vomiting disease” | Contact | Yes | |
| Rubella virus | |||
| Self-limited, mild exanthem with fever: congenital rubella syndrome | Contact | Yes | |
| Salmonella (see Diarrhea/gastroenteritis) | |||
| SARS-associated coronavirus, severe acute respiratory syndrome | Droplet | Yes | |
| Shigella (see Diarrhea) | |||
| Smallpox | |||
| Variola virus (variola major) | Contact, airborne | No (no expressed breast milk) | |
| Vaccinia virus (smallpox vaccine) secondary contact infection | Contact | Yes, except if breast involved with lesions | |
| Staphylococcus aureus | |||
| Cellulitis, abscess | Contact | Yes | Oxacillin, dicloxacillin, first-generation cephalosporins, erythromycin, vancomycin |
| Enterocolitis, diarrhea | Standard | Yes | |
| Scalded-skin syndrome | Contact | Yes (after 24 h of effective therapy; discard breast milk for 24 h) | |
| Toxic shock syndrome | Standard | Yes ** | |
| Methicillin-resistant S. aureus (MRSA) | Contact | Yes ** (after 24 h of therapy, during which milk must be discarded) (If infant becomes ill during evaluation and treatment of mother, infant should be treated for presumed MRSA infection, and breast milk should be withheld until proven to be culture negative.) | Vancomycin, TMP-SMX, clindamycin, linezolid |
| Staphylococcus epidermidis | |||
| Opportunistic infections | Standard | Yes | Oxacillin, dicloxacillin, vancomycin |
| Streptococcus | |||
| Group A: Cellulitis, pharyngitis, pneumonia, myositis/fasciitis, scarlet fever | Standard | Yes (24 h after beginning appropriate therapy; discard breast milk for 24 h) | Penicillin, erythromycin, cephalosporin |
| Contact (for extensive skin infection unable to be covered until after 24 h of therapy) | Yes (24 h after beginning appropriate therapy; discard breast milk for 24 h) | ||
| Group B: Urinary tract infection, endometritis, mastitis; infants: sepsis, pneumonia, meningitis, osteomyelitis, arthritis | Standard | Yes ** (after 24 h of therapy, during which milk must be discarded) (If infant becomes ill during evaluation and treatment of mother, infant should be treated for presumed Streptococcal infection, and breast milk should be withheld until proven to be culture negative.) | Penicillin, ampicillin, third-generation cephalosporin |
| Streptococcus pneumoniae | |||
| Pneumonia, occult bacteremia, otitis media, sinusitis | Standard | Yes | Penicillin, ceftriaxone, vancomycin, cefotaxime, rifampin |
| Syphilis | |||
| Treponema pallidum | |||
| Multisystem, multistage infection with widely varying presentations, congenital infection | Standard | Yes (after 24 h of effective therapy; discard breast milk for 24 h) | Penicillin, doxycycline, tetracycline |
| Open skin lesions of breast or nipples | Contact | No, until 24 h of effective therapy in mother if open skin lesions involve breasts | Penicillin, doxycycline, tetracycline |
| Tetanus | |||
| Exotoxin-mediated severe muscular spasms Clostridium tetani | Standard | Yes (age-appropriate vaccination of the child, no tetanus immunoglobulin [TIG] necessary for infant) | Penicillin, metronidazole |
| Tinea capitis | |||
| Microsporum audouinii | Standard | Yes | Griseofulvin, terbinafine, selenium sulfide shampoo, prednisone |
| Microsporum canis | |||
| Trichophyton tonsurans | |||
| Tinea corporis, cruris, pedis | |||
| Epidermophyton floccosum | Standard | Yes | Topical agents |
| Trichophyton canis | |||
| Trichophyton rubrum | |||
| Tinea versicolor | |||
| Malassezia furfur | Standard | Yes | Topical agents, ketoconazole, itraconazole |
| Toxoplasmosis | |||
| Toxoplasma gondii | Standard | Yes | Pyrimethamine, sulfadiazine, TMP-SMX, dapsone, atovaquone, clindamycin |
| Asymptomatic or mononucleosis-like illness with lymphadenopathy, ocular symptoms; congenital infection | |||
| Toxic shock | |||
| (see S. aureus, Streptococcus [group A]) | |||
| Toxin-mediated illness (see specific agents) | |||
| Bacillus cereus | |||
| Botulism | |||
| Food poisoning | |||
| Staphylococcal scalded-skin syndrome (SSSS) | |||
| Trichinosis | |||
| Trichinella spiralis | |||
| Asymptomatic, or may cause myalgia, periorbital edema, myocardial failure, CNS involvement, or pneumonitis | Standard | Yes | Albendazole, mebendazole, thiabendazole, prednisone |
| Trichomonas vaginalis | |||
| Vaginitis, urethritis, or asymptomatic infections | Standard | Yes | Metronidazole, tinidazole |
| Trypanosomiasis | |||
| Trypanosoma brucei | |||
| “Sleeping sickness”; tsetse fly vector (African) | Standard | No | Suramin, pentamidine, eflornithine, melarsoprol |
| Trypanosoma cruzi | |||
| Chagas disease (American) | Standard | Yes | Nifurtimox, benznidazole |
| TT virus | |||
| Hepatitis | Standard | Yes | |
| Tuberculosis (see mycobacterium in this Appendix; see Chapter 13, Figures 13-2 and 13-3 and Table 13-1 ; see ** Red Book , 30th Edition) | |||
| Tularemia | |||
| Francisella tularensis | |||
| Acute febrile illness with various syndromes; oculoglandular, ulceroglandular, glandular, oropharyngeal, typhoidal, pneumoniae | Standard | Yes | Streptomycin, gentamicin doxycycline, ciprofloxacin |
| Ureaplasma urealyticum | |||
| Nongonococcal urethritis (NGU), endometritis, pelvic inflammatory disease | Standard | Yes | Doxycycline, erythromycin, azithromycin, clarithromycin, ciprofloxacin |
| Urinary tract infection | |||
| Group B streptococcus (see Streptococcus [group B]) | Standard | Yes | Ampicillin, aminoglycosides, cephalosporin |
| Enterobacteriaceal | Standard | Yes | Ampicillin, cephalosporins, fluoroquinolones |
| Staphylococcus saprophyticus | Standard | Yes | Vancomycin, clindamycin + rifampin |
| Vaginitis | |||
| Bacterial | Standard | Yes | Metronidazole, clindamycin |
| Candida albicans (see Candidiasis) | |||
| Varicella-zoster virus (see Herpesviruses) | |||
| West Nile virus | Standard | Yes ** | |
| Asymptomatic, fever, meningoencephalitis | |||
| Whooping cough | |||
| Bordetella parapertussis and Bordetella pertussis : see also Adenovirus, Chlamydia ( Chlamydia pneumoniae , Chlamydia trachomatis ), Mycoplasma pneumoniae as other agents may mimic the clinical picture of whooping cough | Droplet (for 5 days of appropriate therapy and chemoprophylaxis for infant) | Yes, after 5 days of appropriate therapy, breast milk +, P ** | Erythromycin, clarithromycin, TMP-SMX |
| Yellow fever | |||
| Yellow fever virus | Standard | Yes ** | |
| Yellow fever vaccine virus | Standard | No ** | Avoid yellow fever vaccine virus immunization during lactation if possible ** |
| Yersinia enterocolitica | |||
| Diarrhea, pseudoappendicitis, focal infections, and bacteremia | Contact precautions for incontinent individuals | Yes | Cefotaxime, aminoglycosides, TMP-SMX, fluoroquinolones |
| Yersinia pseudotuberculosis | |||
| Fever, rash, abdominal symptoms | Standard | Yes | TMP-SMX |
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