Is Augmentin (amoxicillin and clavulanic acid) safe to use during breastfeeding?

Safety of Augmentin During Breastfeeding

Augmentin (amoxicillin/clavulanic acid) is safe to use during breastfeeding and is recommended as an appropriate antibiotic option for lactating mothers. 1

Evidence for Safety

• Amoxicillin/clavulanic acid is specifically recommended for breastfeeding mothers in clinical practice guidelines, indicating its established safety profile 1
• The FDA drug label acknowledges that ampicillin-class antibiotics (including amoxicillin) are excreted in breast milk but does not contraindicate its use during breastfeeding 2
• While small amounts of the drug are transferred to breast milk, the amount that an infant would ingest is significantly less than therapeutic pediatric doses 3

Clinical Considerations

• In a prospective study comparing amoxicillin/clavulanic acid to amoxicillin alone in breastfeeding women, adverse effects in infants were generally minor and self-limiting 3
• The rate of adverse effects in infants may increase with higher maternal dosages, but these effects typically don't necessitate interruption of breastfeeding 3
• Potential infant side effects to monitor for include:
  • Mild gastrointestinal disturbances 4
  • Changes in stool consistency 3

Recommendations for Clinical Practice

• When prescribing Augmentin to breastfeeding mothers:
  • Use the lowest effective dose for the shortest duration needed 1
  • Advise mothers to monitor their infant for potential side effects such as diarrhea or changes in feeding patterns 3
  • Reassure mothers that most antibiotics, including amoxicillin/clavulanic acid, are compatible with breastfeeding 5

Alternative Options

• If concerns exist about using amoxicillin/clavulanic acid, other antibiotics considered safe during breastfeeding include:
  • Amoxicillin alone (which may have a lower rate of infant side effects) 3
  • Cephalosporins 5
  • Erythromycin or azithromycin 1

Important Considerations

• The benefits of treating maternal infection generally outweigh the minimal risks to the breastfed infant 6
• Temporary interruption of breastfeeding is usually not necessary and can disrupt the nursing relationship 5
• Most commonly used antibiotics, including Augmentin, are relatively safe for breastfed babies as the dose received via milk is generally small 7