Is amoxicillin (Amoxicillin) clavulanic acid safe during breastfeeding?

Amoxicillin-Clavulanic Acid Safety During Breastfeeding

Amoxicillin-clavulanic acid is classified as compatible with breastfeeding and is safe to use for nursing mothers based on current clinical guidelines. 1

Safety Profile and Evidence

• Amoxicillin-clavulanic acid is considered compatible with breastfeeding according to both FDA (Category B) and clinical practice guidelines 1
• The American Academy of Dermatology specifically recommends oral amoxicillin-clavulanic acid for breastfeeding patients who require systemic antibiotics 1
• While amoxicillin is excreted in breast milk, the FDA notes that caution should be exercised when administering amoxicillin-clavulanic acid to nursing women due to potential sensitization of infants 2
• A prospective study comparing amoxicillin-clavulanic acid to amoxicillin alone during lactation found that while adverse effects were more common with the combination (22.3% vs 7.5%), all effects were minor, self-limiting, and did not require interruption of breastfeeding 3

Dosage Considerations

• The rate of adverse effects in infants appears to be dose-dependent, increasing with higher maternal doses of amoxicillin-clavulanic acid 3
• To minimize infant exposure, consider using the lowest effective dose for the shortest duration needed 4
• The safety profile assumes standard recommended doses and durations in the context of healthy, full-term infants 5

Potential Effects on Infants

• The most common concern is mild gastrointestinal effects in breastfed infants due to alteration of intestinal flora 1
• All reported adverse effects in infants have been minor and self-limiting 3
• Breastfed infants should be monitored for:
  • Gastrointestinal symptoms such as diarrhea or changes in stool 5, 1
  • Signs of sensitization or allergic reaction 2

Clinical Advantages

• Amoxicillin-clavulanic acid is preferred over alternatives like doxycycline or clindamycin for breastfeeding mothers due to its safer profile 1
• Most antibiotics, including penicillins, aminopenicillins, and clavulanic acid, are considered compatible with breastfeeding 6

Important Caveats

• If the breastfed infant develops a fever requiring evaluation, be aware that antibiotics in breast milk could potentially cause falsely negative cultures 1
• Consider timing breastfeeding to avoid peak maternal serum drug concentration to further minimize infant exposure 7
• Special consideration should be given to premature or otherwise compromised infants who may have reduced ability to metabolize and eliminate medications 7