HPLC-Based Quantification of Metronidazole Levels in Breast Milk of Post-Cesarean Mothers

HPLC-Based Quantification of Metronidazole Levels

Abstract

In the present context of Nepal, 80% of birth occurs through cesarean delivery. To prevent anaerobic infections, mothers who have undergone cesarean delivery are given metronidazole. Short-term metronidazole medication might cause adverse responses and minor side effects, such as nausea and digestive problems, foul taste, tongue furring, dizziness, drowsiness, and small skin rashes. Pharmacokinetically, breast milk is supposed to be a separate compartment into which the drug is excreted-mainly by passive diffusion.  The main objective of this research was monitoring of metronidazole in the breast milk of mothers who has undergone cesarean delivery. Breast milk samples were collected from 20 lactating mothers who were prescribed Metronidazole, with concentrations measured at 1.5 hours and 4.5 hours post-dose using High-Performance Liquid Chromatography (HPLC). The mean Metronidazole concentration in breast milk was found to be 7.09 mg at 1.5 hours and 6.82 mg at 4.5 hours. The study further examined the relationship between maternal factors, including delivery history and concurrent medication use, on Metronidazole concentration, revealing that first-time mothers had higher concentrations in breast milk compared to mothers with multiple deliveries. Blood samples from infants were also analyzed to assess metronidazole concentrations, and a significant positive correlation (r = 0.9449, p < 0.0001) was observed between infant body weight and drug levels in the blood. The study emphasizes the importance of considering these factors when prescribing medications to breastfeeding mothers to ensure infant safety. Although Metronidazole is considered compatible with breastfeeding by many guidelines, the results suggest that factors such as maternal history, concurrent drug use, and infant weight can influence the extent of drug exposure in breast-fed infants. These findings underscore the importance of personalized medical advice for breastfeeding mothers who are prescribed Metronidazole or other medications.