Which UTI therapies are safe and effective during breastfeeding?
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Trimethoprim/sulfamethoxazole (TMP/SM X) has a high success rate in eradicating bacteriuria for women with urinary tract infection and is compatible with breastfeeding (strength of recommendation: C, based on extrapolation from studies with nonlactating women and disease-oriented outcomes). Quinolones (ciprofloxacin, ofloxacin) are effective and probably compatible with breastfeeding; however, their use has not been recommended by many investigators based on arthropathy in animal studies (SOR: C, based on extrapolation from case series and disease-oriented outcomes). A 7-day course of nitrofurantoin has similar efficacy to TMP/SMX and is compatible with breastfeeding, but it should be avoided in populations at risk for glucose-6-phosphate dehydrogenase (G6PD) deficiency (also known as favism, most often found in patients of Mediterranean or African descent) (SOR: C, extrapolation from studies in nonlactating women and disease-oriented outcomes).
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