Is amoxicillin (amox) safe to use during breastfeeding?

Amoxicillin Safety During Breastfeeding

Amoxicillin is compatible with breastfeeding and is considered safe to use while nursing. 1

Evidence Supporting Safety

Amoxicillin is classified as Category A by the Therapeutic Goods Administration (TGA) and Category B by the FDA, indicating a favorable safety profile during lactation 1. The European Respiratory Society/TSANZ task force specifically lists amoxicillin as "compatible" with breastfeeding in their clinical practice guidelines 1.

Pharmacokinetic Considerations

• Amoxicillin is excreted in breast milk but in small quantities
• The FDA label acknowledges that penicillins are excreted in human milk but primarily raises concerns about potential sensitization of infants rather than direct toxicity 2
• The drug has low oral bioavailability in infants, limiting systemic absorption from breast milk

Potential Concerns

While generally safe, there are some considerations when using amoxicillin during breastfeeding:

• Most systemic antibiotics, including amoxicillin, will be present in breast milk and could potentially:

  • Cause falsely negative cultures if the infant develops a fever requiring evaluation
  • Produce mild gastrointestinal effects due to alteration of intestinal flora 1

• Research on amoxicillin/clavulanic acid (Augmentin) showed that 22.3% of breastfed infants experienced mild, self-limiting adverse effects, with the rate increasing with higher maternal dosages 3

  • These effects did not necessitate interruption of breastfeeding
  • This rate was higher than with amoxicillin alone (7.5%)

Clinical Recommendations

1. First-line choice: Plain amoxicillin is preferred over amoxicillin/clavulanic acid when appropriate for the infection being treated 3

2. Monitoring: Watch for potential infant side effects:

   • Mild diarrhea (most common)
   • Rash
   • Changes in feeding patterns

3. Duration: No restrictions on duration of therapy while breastfeeding, as the drug has established safety

4. Dosing: Standard adult dosing can be used; no need to adjust dosing specifically for breastfeeding status

Special Situations

For mothers with concerns about antibiotic exposure through breast milk:

• Consider timing breastfeeding to occur just before medication administration when possible
• Reassure that the benefits of continued breastfeeding generally outweigh the minimal risks of amoxicillin exposure

Summary

Amoxicillin is one of the safest antibiotics to use during breastfeeding, with extensive clinical experience supporting its compatibility with nursing. The benefits of treating maternal infection while maintaining breastfeeding almost always outweigh the minimal risks to the infant.