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A07AX denotes “Other intestinal antiinfectives” within the group of locally acting antiinfective drugs used in the gastrointestinal tract; it currently comprises broxyquinoline, acetarsol, nifuroxazide and nifurzide. From a toxicological‑lactological viewpoint, these medicines are generally expected to have limited systemic absorption but, because of specific toxicity concerns (notably for older agents such as broxyquinoline and acetarsol), breastfeeding risk must be assessed individually for each substance and product.atcddd.fhi+3

ATC classification and group definition

A07 is the therapeutic subgroup “Antidiarrheals, intestinal anti‑inflammatory/anti‑infective agents” under anatomical group A “Alimentary tract and metabolism” in the WHO ATC system.wikipedia+1
Within A07, A07A “Intestinal antiinfectives” comprises locally acting antiinfective drugs intended for the gut; systemic antiinfectives are classified separately in group J.atcddd.fhi+1

A07AX “Other intestinal antiinfectives” includes agents that cannot be classified into A07AA (antibiotics), A07AB (sulfonamides) or A07AC (imidazole derivatives).atcddd.fhi+1
The current ATC/DDD Index lists the following substances under A07AX: broxyquinoline (A07AX01), acetarsol (A07AX02), nifuroxazide (A07AX03) and nifurzide (A07AX04).atcddd.fhi+1

Pharmacological characteristics of A07AX drugs

Broxyquinoline and related 8‑hydroxyquinoline derivatives act as intestinal antiinfectives with activity against certain protozoa and bacteria, traditionally used for amoebic or non‑specific infectious diarrhoea.atcddd.fhi+1
Acetarsol is an organoarsenical compound with historical use against protozoal infections (e.g., amoebiasis), exerting antiinfective effects but associated with potential systemic arsenic toxicity.atcddd.fhi+1

Nifuroxazide and nifurzide are nitrofuran derivatives that act locally in the intestinal lumen against enteropathogenic bacteria causing acute diarrhoea.atcddd.fhi+1
They are characterised by poor systemic absorption, with antimicrobial action largely confined to the gut, helping to limit systemic adverse effects compared with absorbed antibacterials.atcddd.fhi+1

Therapeutic indications and clinical use

A07AX medicines are used for infectious diarrhoea and intestinal infections where a locally acting antiinfective is considered appropriate, often as short‑course therapy.atcddd.fhi+1
Nifuroxazide and nifurzide are commonly employed for acute bacterial diarrhoea, while broxyquinoline and acetarsol are mainly of historical or restricted use in protozoal intestinal infections due to safety concerns and changing treatment standards.atcddd.fhi+1

Therapeutic regimens vary by substance, formulation, local guidelines and patient factors, but in general A07AX preparations are given orally for limited duration and are not intended for systemic infection management.atcddd.fhi+1
Choice of agent should consider efficacy against the suspected pathogen, local resistance patterns, and safer systemic alternatives (e.g., modern antibiotics) where appropriate.nuemblog+1

DDDs, dosage and administration

The ATC/DDD Index describes A07A as locally acting intestinal antiinfectives and assigns DDDs for utilisation studies.atcddd.fhi+1
For A07AX, the list includes nifuroxazide with a DDD of 0.6 g orally (unit “g”, route “O”), while broxyquinoline, acetarsol and nifurzide are listed without specified DDD values in the current index.atcddd.fhi+1

Clinical dosing of A07AX medicines may differ from DDDs and must follow the approved product information, taking into account age, renal and hepatic function, and comorbidities.ema.europa+1
Treatment duration is typically short (a few days), and prolonged use is discouraged, especially for agents with known systemic toxicity potential such as organoarsenicals.atcddd.fhi+1

Pharmacokinetics relevant to lactation

Nifuroxazide and nifurzide are designed for minimal systemic absorption; most of the dose remains in the intestinal lumen and is excreted unchanged in faeces.atcddd.fhi+1
This low bioavailability leads to low maternal plasma concentrations, which generally limits transfer into breast milk and infant exposure.nuemblog+1

Broxyquinoline and acetarsol may have higher or less predictable systemic absorption and tissue retention due to their chemical nature (8‑hydroxyquinoline derivatives and organoarsenicals, respectively).atcddd.fhi+1
In such cases, potential accumulation and systemic toxicity raise concerns for both mother and breastfed infant, and their use in lactation requires particular caution or avoidance depending on local recommendations.nepis.epa+1

Toxicological profile in adults

Nifuroxazide and related nitrofuran intestinal antiinfectives are usually well tolerated, with adverse effects mainly gastrointestinal (nausea, abdominal pain) and occasional hypersensitivity reactions.atcddd.fhi+1
Serious systemic toxicity is rare due to low absorption, but nitrofuran‑class effects (e.g., rare hepatic or haematologic reactions) may occur in susceptible individuals, warranting vigilance.vinmec

Broxyquinoline and acetarsol carry recognised toxicity risks; 8‑hydroxyquinoline derivatives have been associated historically with neurotoxicity, and organoarsenicals may cause multisystem arsenic toxicity if absorbed.atcddd.fhi+1
Because of these risks and the availability of safer alternatives, use of such agents has declined or is restricted in many settings, and prolonged or high‑dose administration is generally contraindicated.nepis.epa+1

Lactational safety assessment

General lactation pharmacology indicates that most drugs pass into breast milk in small amounts, and many antibiotics and locally acting intestinal antiinfectives are considered compatible with breastfeeding at usual doses.breastfeedingnetwork+1
For low‑absorption A07AX nitrofuran agents (nifuroxazide, nifurzide), infant exposure via breast milk is expected to be small, and the risk of clinically significant toxicity is low when treatment is short and within recommended dosing.atcddd.fhi+1

In contrast, broxyquinoline and acetarsol have less favourable toxicological profiles and theoretical concerns about neurotoxicity or arsenic‑related toxicity in infants if meaningful systemic maternal exposure occurs.atcddd.fhi+1
In breastfeeding women, these agents are best avoided where effective and safer alternatives exist, or used only after careful individualised risk–benefit assessment and specialist consultation.nepis.epa+1

Clinical recommendations for breastfeeding women

When an intestinal antiinfective is required in a breastfeeding woman, preference should be given to agents with established lactational safety, such as systemically absorbed antibiotics that are considered compatible with breastfeeding (e.g., many beta‑lactams and macrolides) or low‑absorption nitrofuran intestinal agents with favourable profiles.breastfeedingnetwork+1
If nifuroxazide or nifurzide is chosen, breastfeeding can usually continue, with observation of the infant for non‑specific gastrointestinal symptoms or allergic reactions, which are uncommon.breastfeedingnetwork+1

Use of broxyquinoline or acetarsol during breastfeeding should generally be avoided; if there is no suitable alternative, a thorough discussion with the patient about potential maternal and infant risks, treatment duration, and possible lactation management strategies (e.g., temporary pumping and discarding) is necessary.nepis.epa+1
In all cases, clinicians should verify product‑specific information, consider the infant’s age and health (especially prematurity or underlying disease), and document the risk–benefit evaluation.ema.europa+1

Educational summary for practice

A07AX “Other intestinal antiinfectives” comprises broxyquinoline, acetarsol, nifuroxazide and nifurzide, all locally acting antiinfective drugs used in the management of infectious diarrhoea and intestinal infections.atcddd.fhi+1
From a toxicological‑lactological perspective, nitrofuran derivatives with low systemic absorption (nifuroxazide, nifurzide) are likely compatible with breastfeeding under usual conditions, whereas older agents with higher toxicity potential (broxyquinoline, acetarsol) warrant caution or avoidance in lactating women.atcddd.fhi+2

Integration of ATC classification, pharmacology, and modern lactation safety guidance enables rational selection of intestinal antiinfectives that treat maternal gastrointestinal infection while maintaining breastfeeding whenever safely possible.wikipedia+1
Healthcare professionals should prioritise medicines with favourable lactational safety, apply individualised risk–benefit assessments, and provide clear counselling to mothers regarding monitoring and continuation of breastfeeding.breastfeedingnetwork+1