Is trans-Pseudomonic acid Safe in Breastfeeding

I am a breastfeeding mother and i want to know if it is safe to use trans-Pseudomonic acid? Is trans-Pseudomonic acid safe for nursing mother and child? Does trans-Pseudomonic acid extracts into breast milk? Does trans-Pseudomonic acid has any long term or short term side effects on infants? Can trans-Pseudomonic acid influence milk supply or can trans-Pseudomonic acid decrease milk supply in lactating mothers?

Because of a small dose used and low absorption through skin (less than 1%), excretion into breast milk in significant amount is unlikely. Despite of it is well absorbed by the gut, it is rapidly and completely metabolized into Monic acid which is a non-active metabolite. However, whenever used on the nipple, it is recommended remove excess of cream by using a gauze. Effectiveness is not higher than purified Lanolin for treatment of sore or cracked nipples. Results in the treatment of nipple infection due to Staph. aureus are less encouraging than with the use of oral antibiotics. Caution should be observed with the application of creams, gels and other products that are indicated for local use if they contain paraffin (Mineral oil) to avoid absorption by the infant.

Because less than 1% is absorbed after topical application, trans-Pseudomonic acid is considered a low risk to the nursing infant.[1] Ensure that the infant's skin does not come into direct contact with the areas of skin that have been treated. Only water-miscible cream or gel products should be applied to the breast because ointments may expose the infant to high levels of mineral paraffins via licking.[2] trans-Pseudomonic acid applied topically to the nipples appears to be relatively ineffective as a treatment for sore, cracked nipples.

A mother who was exclusively nursing her 52-day-old infant developed a soft-tissue infection. She was treated with intravenous teicoplanin 400 mg every 12 hours for 3 doses, then 400 mg daily for 5 days total, intravenous ceftriaxone 1 gram daily, topical trans-Pseudomonic acid cream twice daily. A careful follow-up indicated that her infant had no adverse effects.[3]

A small, randomized, unblinded trial of mothers with sore, cracked nipples was performed. trans-Pseudomonic acid 2% applied to the nipples after each feeding was much less effective (16% vs 79%) than an oral antibiotic (cloxacillin or erythromycin for 10 days) in resolving the problem. Additionally, more patients' condition worsened (28% vs 5%) with trans-Pseudomonic acid than with an oral antibiotic.[4] In a randomized, double-bind trial, lanolin was compared to an all-purpose nipple ointment containing trans-Pseudomonic acid 1%, betamethasone 0.05%, and miconazole 2% for painful nipples while nursing in the first 2 weeks postpartum. The two treatments were equally effective in reducing nipple pain, nipple healing time, breastfeeding duration, breastfeeding exclusivity rate, mastitis and nipple symptoms, side effects or maternal satisfaction with treatment.[5]