Is Augmentin (amoxicillin/clavulanate) safe to use during breastfeeding?

Augmentin (Amoxicillin/Clavulanate) and Breastfeeding

Augmentin is safe and compatible with breastfeeding—it is explicitly recommended by the American Academy of Dermatology and classified as the highest safety designation ("compatible") by the European Respiratory Society guidelines. 1, 2

Safety Classification

• Augmentin receives the highest safety designation for antibiotics during lactation, classified as "compatible" with breastfeeding by the European Respiratory Society/Thoracic Society of Australia and New Zealand (ERS/TSANZ) guidelines. 1
• The American Academy of Dermatology specifically recommends amoxicillin/clavulanic acid as a safe and effective choice during breastfeeding, with FDA Category B classification. 1, 2
• The FDA drug label confirms that amoxicillin is excreted in human milk, though it advises caution should be exercised when administered to nursing women. 3

Clinical Evidence and Rationale

• Penicillins and aminopenicillins, including amoxicillin, are present in breast milk at low concentrations, making the infant exposure minimal. 1
• The European Respiratory Society guidelines explicitly state that breastfeeding should not be interrupted when amoxicillin is prescribed, as the benefits of continued breastfeeding outweigh the minimal risks of exposure through breast milk. 1
• Research confirms that most commonly used drugs, including antibiotics like Augmentin, are relatively safe for breastfed babies, with the dose received via milk being generally small and much less than known safe doses given directly to infants. 4

Infant Monitoring Recommendations

• Monitor all breastfed infants for mild gastrointestinal effects (diarrhea, gastroenteritis) due to potential alteration of intestinal flora, though serious adverse events are rare. 1, 2
• Be aware that antibiotics in breast milk could potentially cause falsely negative cultures if the breastfed infant develops a fever requiring evaluation. 1
• Watch for potential sensitization of infants, as noted in the FDA label, though this is uncommon. 3

Important Caveat to Avoid

• Do not confuse the pregnancy precaution with breastfeeding safety: Amoxicillin/clavulanic acid should not be used in women at risk of pre-term delivery due to a very low risk of necrotizing enterocolitis in the fetus. 1
• However, this caveat applies only to pregnancy/delivery contexts, not to postpartum breastfeeding in term infants—co-amoxiclav remains fully compatible and safe for breastfeeding mothers after term delivery. 1

Prescribing Guidance

• Use the lowest effective dose for the shortest duration needed when prescribing Augmentin to breastfeeding mothers. 2
• Standard adult dosing is 250 mg twice daily up to 500 mg three times daily, or the common formulation of 875 mg/125 mg every 12 hours. 1
• If Augmentin is not suitable, safe alternatives include erythromycin or azithromycin (though azithromycin should ideally be avoided during the first 13 days postpartum). 1, 2