AAFP Issues COVID-19 Guidance on Breastfeeding, Medications

Approved by the Academy's Board of Directors on April 7, the medications policy addresses issues that have arisen regarding investigational medications and therapeutic agents for pre- or postexposure prophylaxis against SARS-CoV-2 infection or treatment of COVID-19.

According to the policy, "There is currently no substantial evidence supporting the off-label use of medications such as chloroquine, hydroxychloroquine, azithromycin and remdesivir for the treatment of COVID-19." No drugs are FDA-approved to prevent or treat COVID-19 at this time, the policy adds, and the AAFP advises against prescribing any medication outside its current indicated uses until further testing is completed.

Furthermore, the policy counsels against stockpiling these medications or prescribing them as a preventive measure for the general public and calls for FPs to continue to provide them for their approved indications unhindered.

In addition, the policy states the Academy's support for rapid evaluation of potential treatments through registered clinical trials, with transparent and timely publication of full results. Finally, the policy calls for clinicians, health care systems and policymakers to consider the evidence and weigh the benefits and harms of any treatment to ensure "judicious and evidence-based use of limited resources."

The breastfeeding statement, which received the Board's thumbs-up on April 15, first calls out the fact that breast milk protects infants against both acute and chronic illnesses. Given that no research to date has documented the presence of SARS-CoV-2 in breast milk, it states, the Academy recommends promoting breastfeeding and parent-infant bonding, as well as avoiding parent-infant separation whenever possible.

The statement considers breastfeeding to be a reasonable choice in parents who have been exposed to COVID-19 but are asymptomatic. These parents should use a mask and practice proper hand hygiene to reduce the risk of exposing an infant to respiratory secretions.

Parents who have been diagnosed with COVID-19 or who were exposed and have symptoms also may breastfeed and/or provide expressed milk. In these instances, the AAFP recommends taking additional steps to reduce exposure, such as limiting contact with the infant and having another member of the household who does not have COVID-19 deliver expressed breast milk. Parents who use a breast pump to express milk should wash their hands before touching any pump or bottle parts and should sanitize the pump after each use.