Augmentin is Safe for Breastfeeding
Augmentin (amoxicillin/clavulanic acid) is explicitly recommended as safe and compatible with breastfeeding by multiple authoritative guidelines, and you should confidently prescribe it to nursing mothers. 1, 2
Evidence-Based Safety Profile
The American Academy of Dermatology classifies Augmentin as FDA Category B and explicitly designates it as "compatible" with breastfeeding, representing the highest safety classification for antibiotics during lactation. 1 This recommendation is echoed across multiple international guidelines, including the European Respiratory Society, which confirms amoxicillin-based antibiotics are compatible with nursing. 1
The key principle: while ampicillin-class antibiotics are excreted in breast milk, the amounts transferred are minimal and do not pose clinically significant risks to healthy, full-term infants. 3, 4
Clinical Recommendations
Continue breastfeeding without interruption when prescribing Augmentin—there is no need to pump and discard milk or delay nursing. 1
Use standard adult dosing (typically 250-500 mg twice to three times daily) without modification for lactation. 1
Monitor the infant for gastrointestinal effects, particularly mild diarrhea or changes in stool pattern, as antibiotics can alter intestinal flora. 1 These effects are typically minor and self-limited. 4
Important Caveats and Monitoring
While Augmentin is safe, be aware of these specific considerations:
Premature or jaundiced infants require extra caution: The FDA label notes that prophylactic amoxicillin/clavulanate in women with premature rupture of membranes may be associated with increased risk of necrotizing enterocolitis in neonates. 3 However, this applies to maternal treatment during pregnancy/delivery, not routine use during established breastfeeding in healthy term infants.
Watch for rare allergic sensitization: Though extremely uncommon, infants can develop hypersensitivity reactions to penicillins transferred through milk. 4
Consider false-negative cultures: If the breastfed infant develops fever requiring septic workup, antibiotics in breast milk could theoretically cause falsely negative bacterial cultures. 1
Alternative Options if Needed
If the mother has a penicillin allergy or Augmentin is not tolerated:
Azithromycin or erythromycin are safe alternatives, though avoid macrolides in the first 13 days postpartum due to very low risk of infantile hypertrophic pyloric stenosis. 1, 2
Cephalexin and other cephalosporins are equally compatible with breastfeeding. 1, 5
Bottom Line for Practice
Do not hesitate to prescribe Augmentin to breastfeeding mothers—the evidence overwhelmingly supports its safety, and the benefits of continued breastfeeding far outweigh the minimal theoretical risks of antibiotic exposure through breast milk. 1, 2, 4 Reassure mothers that they can safely continue nursing while taking this medication, and counsel them to monitor their infant for minor GI changes that typically resolve without intervention.