Amoxicillin Safety During Breastfeeding
Amoxicillin is safe and compatible with breastfeeding according to multiple international guidelines, including the European Respiratory Society and the American Academy of Dermatology. 1, 2
Safety Classification
- Amoxicillin is classified as FDA Pregnancy Category B and is explicitly listed as "compatible with breastfeeding" by the European Respiratory Society/Thoracic Society of Australia and New Zealand (ERS/TSANZ) guidelines 2
- The American Academy of Dermatology states that amoxicillin poses "minimal risk to infant, compatible with breastfeeding" 1
- Penicillins and aminopenicillins, including amoxicillin, are present in breast milk at low concentrations 3
Clinical Approach to Prescribing
When prescribing amoxicillin to breastfeeding mothers:
- Use the lowest effective dose for the shortest necessary duration to minimize infant exposure while maintaining therapeutic efficacy 4
- Breastfeeding should not be interrupted when amoxicillin is prescribed, as the benefits of continued breastfeeding outweigh the minimal risks of amoxicillin exposure through breast milk 2
- Amoxicillin is considered a first-line antibiotic choice for breastfeeding mothers, preferred over alternatives like doxycycline (which should be limited to 3 weeks) and clindamycin (which increases GI side effects in infants) 4, 2
Infant Monitoring
Monitor breastfed infants for the following:
- Changes in stool pattern or consistency due to alteration of intestinal flora 4
- Mild gastrointestinal effects such as diarrhea or gastroenteritis, though serious adverse events are rare 2
- Potential sensitization to penicillins, as noted in the FDA label 5
Important Clinical Caveat
- Antibiotics in breast milk, including amoxicillin, could potentially cause falsely negative cultures if the breastfed infant develops a fever requiring evaluation 4, 2
- This caveat applies to most systemic antibiotics and should be communicated to pediatricians evaluating febrile infants 6
Comparison with Amoxicillin/Clavulanic Acid
- While amoxicillin alone is considered safe, amoxicillin/clavulanic acid requires caution in women at risk of pre-term delivery due to a very low risk of necrotizing enterocolitis, but this concern does not apply to amoxicillin monotherapy 2
- Both formulations are compatible with breastfeeding in term, healthy infants 4, 2