Co-Amoxiclav is Safe for Breastfeeding
Co-amoxiclav (amoxicillin/clavulanic acid) is explicitly recommended as safe and compatible with breastfeeding by the American Academy of Dermatology and is classified as FDA Category B. 1, 2
Safety Classification
The American Academy of Dermatology designates amoxicillin/clavulanic acid as "compatible" with breastfeeding—the highest safety designation for antibiotics during lactation. 1, 2
The FDA classifies co-amoxiclav as Pregnancy Category B, and the drug label confirms that ampicillin-class antibiotics are excreted in breast milk but caution should be exercised. 3
Multiple international guidelines, including the European Respiratory Society, support amoxicillin as compatible with breastfeeding, and this extends to the combination with clavulanic acid. 1, 4
Clinical Evidence
A prospective study of 67 breastfeeding women taking amoxicillin/clavulanic acid found that 22.3% of infants experienced minor adverse effects (primarily mild gastrointestinal symptoms), which were self-limiting and did not require interruption of breastfeeding. 5
The rate of adverse effects increased with higher maternal dosages, but all effects were minor and resolved without intervention. 5
Research confirms that penicillins and aminopenicillins are present in breast milk at low concentrations, minimizing infant exposure. 1
Practical Monitoring Recommendations
Monitor breastfed infants for gastrointestinal effects such as changes in stool pattern, mild diarrhea, or gastroenteritis due to alteration of intestinal flora. 1, 2
Be aware that antibiotics in breast milk could potentially cause falsely negative cultures if the breastfed infant develops fever requiring evaluation. 1, 2
Watch for rare allergic reactions in infants with known hypersensitivity to penicillins, though this is uncommon. 3
Dosing Strategy to Minimize Infant Exposure
Use the lowest effective dose for the shortest necessary duration to minimize infant exposure while maintaining therapeutic efficacy. 2
Standard adult dosing ranges from 250 mg twice daily up to 500 mg three times daily, depending on infection severity. 1
Comparison with Alternative Antibiotics
Co-amoxiclav is preferred over clindamycin, which may increase the risk of GI side effects in infants, including diarrhea, candidiasis, or rarely antibiotic-associated colitis. 1, 2
Co-amoxiclav is preferred over doxycycline, which should be limited to 3 weeks maximum without repeating courses and only used if no suitable alternative exists. 1, 2
Co-amoxiclav has a more established safety profile than newer agents with limited lactation data. 2
Important Caveat for Premature Infants
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, though amoxicillin alone is considered safe. 1
This caveat applies primarily to in utero exposure during labor; for established breastfeeding of full-term healthy infants, co-amoxiclav remains compatible. 1
Breastfeeding Should Continue
- Breastfeeding should not be interrupted when co-amoxiclav is prescribed, as the benefits of continued breastfeeding outweigh the minimal risks of antibiotic exposure through breast milk. 1