THE BREASTFEEDING ANSWER BOOK BACKGROUND NEEDED BASIC INFORMATION 537 milk briefly at a high temperature (short-term pasteurization of 72°C [161.6°F] for 10-15 seconds) kills the virus and preserves more of the beneficial components of human milk but the equipment for this procedure is not yet commercially available (Maschmann 2001; Lawrence and Lawrence, pp. 582, 687; Riordan and Auerbach, p. 231). Food Poisoning When a mother eats a food that is contaminated with specific bacteria or toxins, she may develop “food poisoning,” which can cause vomiting, abdominal cramps, and diarrhea. Food poisoning may be caused by botulism (Clostridium botulinum), listeriosis (Listeria), Salmonella, Shigella, Ciguatera, E. coli, or other bacteria. If a mother has food poisoning, breastfeeding can continue. In the vast majority of cases, food poisoning remits within a few days causing no further problems. It poses no danger to the breastfeeding baby, although the breastfeeding mother with diarrhea and vomiting should be encouraged to drink enough liquids to maintain her fluid balance and avoid dehydration. Some mothers may contract such a severe case of food poisoning that antibiotics are needed, most of which are considered compatible with breastfeeding. Depending upon which bacteria are involved, other precautions may be recommended to prevent airborne or direct-contact transmission between mother and baby, such as careful hand-washing and wearing a mask while breastfeeding (Lawrence and Lawrence, pp. 564-66). Giardia Giardia is a parasitic infection that causes diarrhea and may interfere with the absorption of food. Parasites have caused serious health problems in underdeveloped countries, and parasitic disease is increasing in industrialized countries. Giardia itself is not dangerous to the nursing baby, but one medication used to treat it is controversial when used during breastfeeding. The drug commonly used to treat Giardia lamblia is metronidazole (Flagyl) and is often prescribed as a single 2-gram dose. This drug is prescribed for both premature and full-term babies who have Giardia. Because the medication can cause mutations in developing rat fetuses and cancer in adult rats, the 2001 American Academy of Pediatrics’ “Transfer of Drugs and Other Chemicals into Human Milk” places metronidazole in the category “Drugs Whose Effect on Nursing Infants Is Unknown But May Be of Concern” and recommends the mother “discontinue breastfeeding 12-24 h[ours] to allow excretion of dose when single-dose therapy [is] given....” The baby who continues to breastfeed through the single-dose therapy receives 25.3 mg of metronidazole over the next 48 hours, or about 40 percent of the newborn treatment dose (Passmore 1988; Drinkwater 1987). When breastfeeding is interrupted following the 2-gram single-dose therapy, infants who resume nursing after 12 hours and 24 hours receive 9.8 mg and 3.5 mg of metronidazole respectively over the next 48 hours through their mother’s milk (Drinkwater 1987; Erickson 1981). A lower dose of metronidazole taken for a longer course is an alternative to single-dose therapy that research indicates is compatible with breastfeeding. Passmore (1988) found that 400 mg of metronidazole taken three times per day caused no serious reactions in the infants studied. With this treatment, the babies who were monitored received a dose of 6.25 mg per day, or “less than 10 percent of the recommended daily dose for infants of equivalent age and weight” who are given this drug for Giardia or other infections (Passmore 1988). The USP DI (2001) lists 250 mg of metronidazole taken three times per day over a five-to-seven day course as one of the standard treatments for Giardia. Suggest the mother ask her health care provider if this alternative to single-dose therapy would be appropriate for her and her baby. According to Dr. Thomas Hale, “Thus far, no reports of untoward effects in breastfed infants have been published for the 2 g STAT dose, or the 250 mg three times daily for 10 day dosage regimen” (Hale, p. 482). HEALTH PROBLEMS-MOTHER