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The information provided is taken from various reference sources.  It is provided as a guideline.  No responsibility can be taken by the author or the Breastfeeding Network for the way in which the information is used.  Clinical decisions remain the responsibility of medical and breastfeeding practitioners.  The data presented here is intended to provide some immediate information but cannot replace input from professionals.

Sodium citrate sachets and tablets can be taken by breastfeeding mothers as can cranberry juice. If symptoms persist antibiotics may need to be prescribed – please take a mid-stream urine specimen with you

Cystitis is an inflammation of the bladder which may or may not be accompanied by bacterial infection. NHS Clinical Knowledge Summaries indicates that without antibiotics most cases resolve between four and nine days and antibiotics speed the process by around 24 hours.

Symptoms include pain on urination (dysuria), frequency and urgency as well as a feeling of being unable to empty the bladder completely. Any woman who has had symptoms for more than five days, or who has fever or loin pain should see a doctor because the symptoms could indicate a bacterial infection needing prompt treatment with antibiotics. 

Patient information leaflets and packaging of over-the-counter remedies for cystitis generally advise that they should not be used during breastfeeding. The manufacturers are not required to conduct any safety tests in terms of breastmilk when first licensing a product and therefore do not take responsibility. It does not indicate risk. 

Over the counter products contain sodium citrate in tablets or sachets to be dissolved in water. Sodium citrate is metabolised to bicarbonate after absorption. There appears to be no data on the pharmacokinetics controlling absorption and passage into breastmilk but it is likely to be limited, particularly with a 48-hour course, and is unlikely to adversely affect a breastfed infant. Sodium citrate is also an ingredient of formula milk. It is important to drink additional watery fluids to speed resolution of symptoms. Cranberry juice and cranberry capsules can also be taken during breastfeeding. 

Brand names: Effercitrate ®, Cystopurin ®, Cystemme ®, Canesten Oasis, Own brand cystitis relief

Most antibiotics for urinary tract infections are safe to use during breastfeeding. See fact sheet on antibiotics and breastfeeding.   https://www.breastfeedingnetwork.org.uk/antibiotics/.

Bibliography

• Hale T. W Medications in Mothers Milk
• Jones W Breastfeeding and Medication 2019 Routledge
• Lactmed website http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT
• Martindale, the Extra Pharmacopia 2007
• NHS Clinical Knowledge Summaries
• Rutter P. Community Pharmacy; symptoms, diagnosis and treatment. Churchill Livingstone 2004. British National Formulary

©Dr Wendy Jones MBE, MRPharmS and the Breastfeeding Network March 2022