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

Augmentin Safety in Pregnancy

Yes, Augmentin (amoxicillin-clavulanate) is safe to use throughout pregnancy when clinically indicated for bacterial infections. 1, 2

Safety Classification and Evidence Base

The European Respiratory Society/Thoracic Society of Australia and New Zealand categorizes amoxicillin/clavulanate as "Compatible" for use during pregnancy. 1 Clinical practice guidelines from the American College of Gastroenterology support its use when treating maternal infections, as the benefit of treating bacterial infections generally outweighs theoretical risks to the fetus. 1, 2

Teratogenicity Risk

Augmentin does not increase the risk of congenital abnormalities. 1, 3 A large population-based case-control study of 6,935 pregnant women with offspring having congenital abnormalities compared to 10,238 controls found no increased risk of birth defects with augmentin treatment (odds ratio 1.4,95% CI 0.9-2.0, not statistically significant). 3 Reproduction studies specifically for the amoxicillin-clavulanate combination showed no increased occurrence of fetal malformations or harmful effects. 1

Critical Exception: Preterm Delivery Risk

Augmentin is NOT recommended in women at risk of preterm delivery due to a very low but documented risk of necrotizing enterocolitis in the fetus. 1 In these specific cases, consider alternative antibiotics if clinically appropriate. 1

Clinical Decision Algorithm

When prescribing Augmentin during pregnancy:

1. Confirm bacterial infection requiring antibiotic therapy based on clinical presentation and culture results when possible 1

2. Assess preterm delivery risk - if present, choose an alternative antibiotic 1

3. If no preterm delivery risk exists, Augmentin can be used as a safe first-line option throughout all trimesters of pregnancy 1, 2

4. Consider maternal infection risks - untreated infections can lead to preterm birth, low birth weight, and spontaneous abortion, making treatment essential 2

Breastfeeding Compatibility

Amoxicillin-clavulanate is compatible with breastfeeding according to the ERS/TSANZ task force. 1