Can you take tobramycin while breastfeeding?
What LactMed says
The National Library of Medicine’s own summary, quoted in full. We do not write a verdict of our own on this question, and we do not compress theirs into a label.
Tobramycin is poorly excreted into breastmilk. Newborn infants apparently absorb small amounts of other aminoglycosides, but serum levels with three times daily dosages are far below those attained when treating newborn infections and systemic effects of tobramycin are unlikely. Older infants would be expected to absorb even less tobramycin. Because there is little variability in the milk tobramycin levels during multiple daily dose regimens, timing breastfeeding with respect to the dose is of little or no benefit in reducing infant exposure. Data are not available with single daily dose regimens. Monitor the infant for possible effects on the gastrointestinal flora, such as diarrhea, candidiasis (e.g., thrush, diaper rash) or rarely, blood in the stool indicating possible antibiotic-associated colitis.
Maternal use of an ear drop or eye drop that contains tobramycin presents little or no risk for the nursing infant. A task force respiratory experts from Europe, Australia and New Zealand found that inhaled tobramycin is compatible with breastfeeding.
Quoted from Tobramycin — Drugs and Lactation Database (LactMed®), National Institute of Child Health and Human Development, revised October 15, 2024.
How much tobramycin gets into breastmilk
Maternal Levels. After a single 80 mg intramuscular dose of tobramycin in 5 women, milk levels were measured every hour for 6 hours. Only trace levels were detected in 4 of the samples from 1 to 8 hours after the dose. In the fifth woman, milk levels ranged from 0.4 to 0.52 mg/L over 8 hours, with the highest level found at 4 hours after the dose.
In one patient who received 80 mg of tobramycin every 8 hours by intramuscular injection, milk levels were 0.6 mg/L 1 hour after the dose and 0.58 mg/L 8 hours after the dose.
At 2 months postpartum, a woman was receiving intravenous tobramycin 150 mg 3 times daily plus meropenem for cystic fibrosis. Four days after beginning, milk tobramycin levels were undetectable (<0.18 mg/L) before the infusion and in 6 milk samples taken from 1 to 5 hours after the infusion.
Infant Levels. Relevant published information was not found as of the revision date.
What has been seen in breastfed infants
An infant was breastfed (extent not stated) until the 4th month postpartum. At 2 months of age, his mother was given a 2-week course of tobramycin 150 mg three times daily plus meropenem for a cystic fibrosis exacerbation. infant displayed no change in stool pattern during the maternal treatment and had normal renal function at 6 months of age.
Effects on milk supply
Relevant published information was not found as of the revision date.
Frequently asked questions
Can you take tobramycin while breastfeeding?
Tobramycin is poorly excreted into breastmilk. The full record is quoted on this page, and the decision is one to make with the person who prescribed it — LactMed itself states it is not a substitute for professional judgement.
Does tobramycin pass into breastmilk?
LactMed's measured drug levels for tobramycin are quoted in full on this page, under "How much gets into breastmilk".
Do I need to pump and dump after taking tobramycin?
LactMed does not frame its records that way — it reports measured drug levels in milk and what has been observed in breastfed infants, which is what this page quotes. "Pump and dump" advice for a specific drug and dose should come from your clinician or a pharmacist, not from a general rule.
More on tobramycin
LactMed states that the information it presents is not a substitute for professional judgement, and that you should consult your healthcare provider for breastfeeding advice related to your particular situation. Nothing on this page is medical advice.