Is Augmentin (amoxicillin-clavulanate) safe to use during breastfeeding?

Safety of Augmentin During Breastfeeding

Augmentin (amoxicillin-clavulanate) is safe to use during breastfeeding and is compatible with lactation.

Evidence Supporting Safety

Amoxicillin-clavulanate is considered compatible with breastfeeding according to multiple guidelines:

• The 2020 European Respiratory Journal guidelines specifically list amoxicillin-clavulanate as "compatible" with breastfeeding 1.
• The FDA drug label acknowledges that penicillins (including amoxicillin) are excreted in human milk but only advises caution rather than contraindication 2.
• The 2025 North American Clinical Practice Guidelines for Hidradenitis Suppurativa management suggest using amoxicillin/clavulanate during breastfeeding 1.

Mechanism and Transfer into Breast Milk

• Penicillins are excreted in human milk but in small amounts.
• The relative infant dose (infant dose mg/kg/day divided by maternal dose mg/kg/day) is considered safe when <10% 1.
• Amoxicillin-clavulanate has minimal absorption through an infant's gastrointestinal tract, further reducing potential exposure.

Recommendations for Use During Breastfeeding

When prescribing Augmentin to breastfeeding mothers:

• Use the lowest effective dose for the shortest duration possible
• Consider timing medication administration:
  • Take medication immediately after breastfeeding to maximize clearance time before the next feeding 3
  • This timing strategy minimizes infant exposure

Special Considerations

• Exercise extra caution with infants less than 6 weeks of age due to immature hepatic and renal function 4
• Older infants (>6 months) have more mature metabolism and are at lower risk for adverse effects 4
• Potential but rare side effects in infants may include:
  • Modification of gut flora
  • Possible diarrhea
  • Allergic sensitization (rare)

Clinical Perspective

The benefits of treating maternal infection with Augmentin typically outweigh the minimal risks to the breastfed infant. Untreated maternal infections can:

• Compromise maternal health
• Interfere with successful breastfeeding
• Potentially expose the infant to infection

Algorithm for Decision-Making

1. Confirm that Augmentin is the appropriate antibiotic for the maternal infection
2. Prescribe standard adult dosing (no special dosage adjustment needed for lactation)
3. Advise mother to take medication immediately after breastfeeding
4. Monitor infant for rare side effects (diarrhea, rash)
5. Continue breastfeeding as normal

In conclusion, Augmentin can be safely used during breastfeeding with minimal risk to the infant, and the maternal benefits of treating infection outweigh the potential risks to the breastfed infant.