Is ampicillin (Ampicillin) and sulbactam safe for breastfeeding?

Ampicillin and Sulbactam Safety During Breastfeeding

Ampicillin and sulbactam are considered compatible with breastfeeding and can be safely used by nursing mothers. 1

Safety Profile

• Ampicillin and sulbactam are classified as compatible with breastfeeding according to clinical guidelines, with penicillins generally considered low risk during lactation 2
• The FDA drug label confirms that low concentrations of ampicillin and sulbactam are excreted in breast milk, but does not contraindicate its use during breastfeeding 1
• Penicillins as a class (including ampicillin combinations) are considered to have minimal risk to the breastfed infant 3

Clinical Considerations

• While ampicillin and sulbactam do pass into breast milk, the amounts are small and the oral bioavailability in infants is generally low 2
• Similar to other penicillin combinations like amoxicillin/clavulanic acid, ampicillin/sulbactam has a favorable safety profile during breastfeeding 4
• Research studies have demonstrated that penicillin-class antibiotics, including those with beta-lactamase inhibitors like sulbactam, can be used safely during lactation 5, 6

Potential Side Effects in Breastfed Infants

• The most common potential side effect is mild gastrointestinal disturbance in the infant due to alteration of intestinal flora 4, 7
• These effects are typically minor, self-limiting, and do not require interruption of breastfeeding 6
• There is a theoretical concern that antibiotics in breast milk could potentially cause falsely negative cultures if the breastfed infant develops a fever requiring evaluation 7

Recommendations for Use

• Use the lowest effective dose for the shortest duration needed to minimize infant exposure 4
• No special monitoring of the infant is required beyond observation for potential gastrointestinal effects 3
• There is no need to interrupt or "pump and dump" breast milk during treatment with ampicillin/sulbactam 5

Special Considerations

• The safety profile assumes a healthy, full-term infant; additional caution may be warranted in premature infants or those with other medical conditions 7
• If the infant develops diarrhea, rash, or other concerning symptoms during maternal treatment, consult a healthcare provider 1

Alternative Antibiotics

• If concerns remain about ampicillin/sulbactam use, other antibiotics with established safety during breastfeeding include amoxicillin alone, cephalosporins, and macrolides (with caution in the first two weeks of life) 2, 7