Is co-amoxiclav (amoxicillin/clavulanic acid) safe to use in a lactating mother?

Co-Amoxiclav Safety in Lactating Mothers

Co-amoxiclav (amoxicillin/clavulanic acid) is safe and compatible with breastfeeding and is explicitly recommended by the American Academy of Dermatology as a safe and effective choice for lactating mothers. 1

Guideline-Based Safety Classification

Co-amoxiclav is classified as FDA Category B and is explicitly listed as "compatible" with breastfeeding by multiple international guidelines, including the European Respiratory Society. 1

• The American Academy of Dermatology specifically recommends amoxicillin/clavulanic acid as a safe and effective choice during breastfeeding 1, 2
• Amoxicillin alone is classified as "compatible" with breastfeeding by the European Respiratory Society/Thoracic Society of Australia and New Zealand (ERS/TSANZ) guidelines 1
• The FDA drug label confirms that ampicillin-class antibiotics (including amoxicillin) are excreted in milk, but caution rather than contraindication is advised 3

Transfer to Breast Milk and Infant Exposure

• Penicillins and aminopenicillins, including amoxicillin, are present in breast milk at low concentrations 1
• The low oral bioavailability of these antibiotics means minimal systemic absorption occurs in the breastfed infant 1
• Research confirms that most antibiotics, including co-amoxiclav, are considered compatible with breastfeeding 4, 5

Infant Monitoring Considerations

All breastfed infants whose mothers are taking co-amoxiclav should be monitored for gastrointestinal effects, though serious adverse events are rare. 1

• A prospective study found that 22.3% of infants exposed to amoxicillin/clavulanic acid had minor adverse effects (primarily gastrointestinal), with rates increasing with higher maternal dosages 6
• This rate was higher than amoxicillin alone (7.5%), but all adverse effects were minor, self-limiting, and did not necessitate interruption of breastfeeding 6
• Antibiotics in breast milk may alter intestinal flora, potentially causing mild diarrhea or gastroenteritis in the infant 1
• Antibiotics in breast milk could potentially cause falsely negative cultures if the breastfed infant develops fever requiring evaluation 1

Clinical Algorithm for Use

First-line approach: Prescribe co-amoxiclav at standard recommended doses without interrupting breastfeeding 1

Monitoring protocol:

• Observe infant for gastrointestinal symptoms (diarrhea, irritability, feeding changes) 1, 6
• If mild GI symptoms occur, continue breastfeeding as effects are self-limiting 6
• Consider dose reduction if significant infant symptoms develop, though this is rarely necessary 6

Important Caveats

Critical pregnancy consideration (not applicable to breastfeeding but worth noting): The European Respiratory Society guidelines recommend caution when using amoxicillin/clavulanic acid in women at risk of pre-term delivery due to a very low risk of necrotizing enterocolitis in neonates, but this concern does not apply to breastfeeding exposure 1

• The benefits of continued breastfeeding outweigh the minimal risks of co-amoxiclav exposure through breast milk 1
• Breastfeeding should not be interrupted when co-amoxiclav is prescribed 1
• No dosage adjustment is needed for the mother based on breastfeeding status 5