Amoxicillin/Clavulanic Acid is Safe During Breastfeeding
Amoxicillin/clavulanic acid is classified as compatible with breastfeeding and is recommended as a safe and effective first-line antibiotic choice for nursing mothers. 1, 2
Guideline Recommendations
The American Academy of Dermatology explicitly recommends amoxicillin/clavulanic acid as a safe option during breastfeeding, supported by high-quality evidence. 1, 2 This recommendation is reinforced by:
- FDA Category B classification, indicating no evidence of risk in humans 2, 3
- Multiple clinical practice guidelines from major medical societies supporting its use 4, 1
- Direct evidence from lactation studies showing safety in nursing infants 5
What to Expect and Monitor
While amoxicillin/clavulanic acid is safe, minor gastrointestinal effects may occur in breastfed infants:
- Approximately 22% of infants may experience mild GI symptoms (diarrhea, irritability, or altered stool patterns), which are self-limiting and do not require discontinuation of breastfeeding 5
- The rate of adverse effects increases with higher maternal doses, so use the lowest effective dose for the shortest necessary duration 2, 5
- All documented adverse effects have been minor and resolved without intervention 5
Monitor your infant for:
- Changes in stool pattern or consistency 4, 1
- Increased fussiness or feeding difficulties 5
- Skin rash (rare sensitization) 3
Important Clinical Considerations
Amoxicillin is excreted in human milk, as stated in the FDA label, but this does not contraindicate breastfeeding—rather, it requires awareness and monitoring. 3
Practical Advantages Over Alternatives
Amoxicillin/clavulanic acid is preferred over several other antibiotics during lactation:
- Safer than clindamycin, which carries higher risk of infant GI side effects 1, 2
- Safer than doxycycline, which should be limited to maximum 3 weeks if no alternative exists 1, 2
- More established safety profile than newer agents with limited lactation data 4
Potential Pitfall to Avoid
If your breastfed infant develops a fever requiring medical evaluation while you are taking this antibiotic, inform the pediatrician that the infant may have antibiotic exposure through breast milk, as this could potentially cause falsely negative bacterial cultures. 1, 2
Dosing Strategy
To minimize infant exposure while maintaining therapeutic efficacy:
- Use the lowest effective dose for your infection 2
- Treat for the shortest appropriate duration 2
- Standard therapeutic dosing does not require interruption of breastfeeding 4, 5
Bottom Line for Clinical Practice
Continue breastfeeding while taking amoxicillin/clavulanic acid. The benefits of breastfeeding far outweigh the minimal risks of infant exposure to this antibiotic. 6, 5, 7 No interruption of nursing is necessary, and the medication can be taken on your regular schedule without timing around feedings. 4, 5