Is it safe to take Augmentin (amoxicillin/clavulanate) while breastfeeding?

Safety of Augmentin (Amoxicillin/Clavulanate) During Breastfeeding

Augmentin (amoxicillin/clavulanate) is safe to use while breastfeeding and is specifically recommended as one of the safest antibiotic options for nursing mothers. 1

Evidence Supporting Safety

Amoxicillin/clavulanate is considered a preferred antibiotic choice during breastfeeding for several reasons:

• The American Academy of Dermatology specifically recommends it as one of the safest options for breastfeeding mothers 1
• Penicillins, including amoxicillin, are excreted in breast milk but only in small amounts 2
• While the FDA label notes that "amoxicillin use by nursing mothers may lead to sensitization of infants" and advises caution, this represents a theoretical concern rather than documented harm 2

Potential Concerns and Monitoring

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

• In a comparative study, amoxicillin/clavulanate showed a higher rate of minor adverse effects in infants (22.3%) compared to amoxicillin alone (7.5%), with the rate increasing with higher maternal dosages 3
• These adverse effects were all minor, self-limiting, and did not require interruption of breastfeeding 3

Signs to Monitor in the Infant

When taking Augmentin while breastfeeding, monitor your baby for:

• Diarrhea (most common)
• Rash or allergic reactions
• Unusual irritability or lethargy
• Candidiasis (thrush, diaper rash) 1

Practical Recommendations

To minimize potential effects on your breastfeeding infant:

1. Timing: Take medication immediately after breastfeeding to maximize the time before the next feeding
2. Dosing: Use the lowest effective dose for the shortest duration needed
3. Hydration: Maintain adequate fluid intake to help clear the medication from your system
4. Alternative antibiotics: If concerns arise, azithromycin and erythromycin are also considered safe alternatives during breastfeeding 1

Comparison to Other Antibiotics

When comparing antibiotic options during breastfeeding:

• Amoxicillin/clavulanate, azithromycin, erythromycin, metronidazole, and rifampin are all considered safe 1
• Clindamycin should be used with more caution due to potential GI side effects in infants 1
• Doxycycline should be limited to courses ≤3 weeks 1

Bottom Line

The benefits of treating maternal infection with Augmentin generally outweigh the minimal risks to the breastfed infant. Most commonly used antibiotics, including Augmentin, pass into breast milk in amounts much smaller than therapeutic doses given directly to infants 4. Continue breastfeeding while taking Augmentin, but monitor your infant for any unusual symptoms.