Can a breastfeeding patient take Augmentin (amoxicillin/clavulanate) and prednisone?

Can a Breastfeeding Patient Take Augmentin and Prednisone?

Yes, both Augmentin (amoxicillin/clavulanate) and prednisone are safe to use during breastfeeding, with specific dosing considerations for prednisone above 20 mg daily. 1, 2

Augmentin (Amoxicillin/Clavulanate) Safety

Amoxicillin/clavulanate is explicitly classified as "compatible" with breastfeeding and represents one of the safest antibiotic choices for nursing mothers. 2

• The American Academy of Dermatology recommends amoxicillin/clavulanic acid as a safe and effective choice during breastfeeding, classified as FDA Category B and compatible with breastfeeding 2
• The European Respiratory Society/Thoracic Society of Australia and New Zealand (ERS/TSANZ) guidelines classify co-amoxiclav as "compatible" with breastfeeding, representing the highest safety designation for antibiotics during lactation 2
• The FDA drug label confirms that amoxicillin is excreted in human milk, but caution should be exercised when administered to a nursing woman 3

Infant Monitoring for Augmentin

• All breastfed infants whose mothers are taking co-amoxiclav should be monitored for mild gastrointestinal effects, though serious adverse events are rare 2
• Antibiotics in breast milk may alter intestinal flora, potentially causing mild diarrhea or gastroenteritis in the infant 2
• Antibiotics in breast milk could potentially cause falsely negative cultures if the breastfed infant develops a fever requiring evaluation 2

Important Caveat

• 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, but for breastfeeding after term delivery, co-amoxiclav remains fully compatible and safe 2

Prednisone Safety During Breastfeeding

Prednisone can be safely used during breastfeeding with no special precautions needed for doses ≤20 mg daily. 1

Dosing Algorithm for Prednisone

• For doses ≤20 mg daily: No interruption in breastfeeding is necessary 1
• For doses >20 mg daily: Women should delay breastfeeding or discard breast milk accumulated in the 4 hours following glucocorticoid administration 1

Clinical Application

• Corticosteroids have been used extensively during breastfeeding with no evidence of harmful effects on infants 1
• For breastfeeding patients requiring systemic immunomodulators, prednisone ≤20 mg daily is recommended only for acute, widespread flares 1
• If >20 mg daily is required, plan administration around the breastfeeding schedule and wait at least 4 hours before the next breastfeeding session 1
• Consider pumping and discarding milk during this 4-hour window if needed 1

Combined Use Considerations

Both medications can be used simultaneously during breastfeeding without contraindication. 1, 2

• Maintaining maternal disease control with lactation-compatible medications is important for both mother and infant health 1
• The benefits of continued breastfeeding outweigh the minimal risks of medication exposure through breast milk 2

Common Pitfalls to Avoid

• Using higher doses of steroids than necessary 1
• Failing to consider the timing of medication administration in relation to breastfeeding schedule when prednisone doses exceed 20 mg daily 1
• Unnecessarily discontinuing breastfeeding when safe alternatives exist 2