A dog bit me... now lots of meds. Docs suggest I wean my 3yo.

[treehugz]

X-posted in Breastfeeding Challenges. I was bit by a pit bull yesterday... two punctures in my thumb.  The docs have started me on clindamycin and cipro and gave me a tetanus booster.  Plus I had just started using a ketoconozole cream for tinea versicolor (a last resort).  The dog is in quarantine for 10 days to see if I need to do the rabies prophylaxis... dog was overdue for his vacs by >1 year.

My dd is 3yr 2mo, and I have gone without any prescription or over counter med since I got pregnant with her until this week.  I had planned to do child-led weaning, but docs suggest that I consider weaning her now due to the meds.  She bfs ~5 times a day... I've never had luck pumping.  I'd love some support and/or ways to reduce the meds in my milk so I can continue bfing... but do tell me if I really do need to wean.

[HappyMonkey]

So sorry this happened to you. I don't have advice about the meds.. but I do know that when they test titers the average rabies shot actually lasts the dog 7 years... the yearly shots are considered quite absurd by many. So if the dog has had a rabies shot in the past 7 years it's likely they would still be protected.

How long do the meds last? Maybe you could just take a pause from BFing and go back to it after?

[PatioGardener]

can you call http://www.infantrisk.com/ ? they can tell you the safety of the meds and maybe offer safer versions if needed.

i wouldn't trust a doc who told me to wean unless i was starting chemo or it was jack newman himself!

[treehugz]

Quote:

Originally Posted by PatioGardener 

can you call http://www.infantrisk.com/ ?

Thanks!  I'm going to call first thing in the morning.
 

[treehugz]

Originally Posted by HappyMonkey 

So sorry this happened to you. I don't have advice about the meds.. but I do know that when they test titers the average rabies shot actually lasts the dog 7 years... the yearly shots are considered quite absurd by many. So if the dog has had a rabies shot in the past 7 years it's likely they would still be protected.

How long do the meds last? Maybe you could just take a pause from BFing and go back to it after?

Good to know about the 7 years... that's a relief... don't want to be dealing with that too.  The meds are for 5 days and 7 days, so I'll be done next Wednesday.  I don't have a great milk supply... so not sure if it would hold out a week or not.  I've been drinking a Mother's Milk and a Yogi Milk tea every day for over a year to keep my supply going.

[CheriK]

Remember that a 3 year old, especially if mom's milk supply isn't great, isn't getting much medication even for those that transfer into milk at high rates.  And her body (liver and kidneys) is mature enough to be able to metabolize any drugs she does recieve much more easily. 

Don't have time to type many details, but Hale's Medications & Mother's Milk 2010 lists clindamycin as an L2, and it is on the AAP listing of medications usually compable w/ breastfeeding.  Cipro is an L3 (concerns w/ the possibility of diarrhea in breastfed infants), but is used in pediatrics regularly and is on the AAP approved list as well.  Ketoconazole is an L2, also on AAP approved list.  Rabies vax is an L3 due to no data available on transfer, but says unlikely to have effects.

Yes, it's a lot of medications, but none are particularly alarming.  I would second calling Infantrisk just for reassurance, and for information to share w/ your doctors.  You might also contact your DD's pediatrician, as they are often better informed about these types of risks.  Remember that most doctors are not particularly well informed about breastfeeding & medication, and usually will recommend the lowest risk (to them) solution - which means weaning.  That doesn't mean high risk, often it's just CYA unfortunately. 

[treehugz]

Thanks CheriK!  I just talked with someone at InfantRisk... they were fantastic!  She took all my information and gave me all the facts about the medications... she said almost the same things you said CheriK.  She told me how long after I took each of the meds that the concentration would be highest in my milk and how long after that most of the meds would be completely out of my system.  This was really helpful.  So I feel safe bfing 6 hours after taking the meds now... certainly different from my whenever-you-want-it approach, but so far dd is cooperating with it.  One interesting thing... she said they don't know if rabies virus can be passed through breast milk or not, just weren't any test cases...

Sadly, I think I'm getting a yeast infection now too... so I'm loading up on yogurt when it won't interfere with the meds to bring the yeast in check... certainly don't want to add yet another medication to the mix for that!  But I guess when it rains it pours!

[CheriK]

Oh, I'm so sorry about the yeast.  Figures, though, doesn't it?  I know the idea of more meds is probably not appealing right now, but starting fluconazole right away might prevent your DD from also getting it, and 3 year olds aren't always cooperative about treatment, just in case it turns into thrush.  Active-culture yogurt is great, but you might want to take a probiotic supplement as well to ensure you're getting a high concentration of the good bugs.  And some folks believe that the probiotics don't do much good when you're still on antibiotics (because, after all, it's the abs that are killing them off in the first place), so definitely keep it up for a week or two after you're done with the meds.  Rinsing your nipples w/ plain water, or a 10% vinegar solution (some moms will add tea tree oil or grapefruit seed extract) might help prevent thrush, as well.  And a really really good diet, lots of healthy veggies, whole grains, avoid simple carbs and sugars which will feed the yeast. 

Good luck.  Hope you're healing otherwise.

[foreverinbluejeans]

The US has been free of the canine rabies virus since 2004. The latest statistics I could find are that there have been 3 cases of rabies in humans since 2006. A rabid animal could bite a dog and the dog could then bite a human, that is how those people probably got rabies. The risk of rabies is amazingly small.

It may seem to you like you are on a lot of medications. However, mothers with chronic and/or acute health conditions may be on many medications and continue to breastfeed. I became very ill while pregnant with my youngest child. I was diagnosed with asthma and had pneumonia several times and other serious infections. After his birth I was diagnosed with adult onset genetic immune deficiencies and cancer. Because my immune system doesn't work right I get bacterial and yeast infections easily and have other autoimmune conditions. I was on at least 10 medications the whole time I breastfed. I had to be on IV antibiotics during hospitalizations and for weeks at a time at home. I had IV gamma globulin every 3 weeks at the hospital or at home.

Looking back I don't know how I did it but my son never had anything except my milk. I breastfeed until he weaned himself when he was almost 3. He was also diagnosed with immune deficiencies when only a few weeks old and doctors were very supportive of breastfeeding. A LLL Leader's son was a doctor at the hospital I went to when I had to have outpatient IV meds, IV meds in the ER, or had to stay as an inpatient. He was supportive if any of the staff started giving me a hard time about breastfeeding and meds or keeping my baby with me. My son survived (a baby with the disease we have only has a little over 50/50 chance of surviving) and is now 24 and 6'4" tall!

I would be more concerned about weaning a child before they are ready than antibiotics and a tetanus shot.

[Kristin0105]

Sorry you are going through this. When my dd was 2 I was bitten by a dog who did not have a rabies shot. I had to undergo rabies Ig shots, lots of them for weeks. The er doc. suggested weaning because they did not know if the Ig would enter the breast milk. for the record it was necessary to start the shots w/i 48 hours of the bite because if you wait the 10 days of quarantine it's too late if the animal has rabies. Anyway, the antibiotics made my dd sick and I stopped them. Don't recall what I was on, I am allergic to some antibiotics so my choices are limited. Anyway, my dd appears normal so I don't think the were lasting effects. Had she been younger II would have been more concerned but as it was my decision was get the shots or dd could end up without a Mother. At the time I had no info. on the likelihood of contracting the disease only that the time frame was limited.