Can a lactating mother be prescribed Augmentin (amoxicillin‑clavulanate)?

Can Augmentin Be Given When a Mother Is Breastfeeding?

Yes, Augmentin (amoxicillin/clavulanic acid) is safe and compatible with breastfeeding and should not require interruption of nursing. 1, 2, 3

Safety Classification and Evidence Base

Augmentin is classified as FDA Pregnancy Category B and explicitly designated as "compatible" with breastfeeding by major medical societies, representing the highest safety designation for antibiotics during lactation. 1, 2 This classification is supported by:

• The American Academy of Dermatology recommends amoxicillin/clavulanic acid as a safe and effective first-line choice during breastfeeding with high-quality evidence 1, 2
• The European Respiratory Society/Thoracic Society of Australia and New Zealand (ERS/TSANZ) guidelines classify it as "compatible," the strongest safety endorsement 1, 2
• The FDA drug label confirms that amoxicillin is excreted in human milk but caution (not contraindication) should be exercised 3

Clinical Recommendations for Prescribing

When prescribing Augmentin to a breastfeeding mother, use standard therapeutic doses without interrupting breastfeeding. 1, 2 The algorithmic approach is:

• First-line choice: Prescribe Augmentin at standard adult dosing (typically 500 mg/125 mg three times daily or 875 mg/125 mg twice daily) 1
• No need to pump and dump: Breastfeeding should continue normally throughout treatment 1
• Duration: Use the shortest effective duration needed for the maternal infection 2
• Monitoring: Advise the mother to watch for mild gastrointestinal changes in the infant (see below) 1, 2

Infant Monitoring and Expected Effects

Breastfed infants should be monitored for mild, self-limiting gastrointestinal effects due to alteration of intestinal flora. 1, 2, 4 Specifically:

• The most common potential effect is mild diarrhea or changes in stool consistency 1, 2
• A prospective study found 22.3% of infants exposed to amoxicillin/clavulanic acid had minor adverse effects (compared to 7.5% with amoxicillin alone), but all were self-limiting and did not require stopping breastfeeding 4
• The rate of adverse effects increased with higher maternal doses, but remained minor 4
• No serious adverse events have been documented in full-term, healthy breastfed infants 1, 4

Advantages Over Alternative Antibiotics

Augmentin is preferred over several other antibiotics for breastfeeding mothers: 1, 2

• Safer than clindamycin: Oral clindamycin may increase risk of GI side effects in infants, including diarrhea, candidiasis, or rarely antibiotic-associated colitis 1
• Safer than doxycycline: Tetracyclines should be limited to 3 weeks maximum and only used when no suitable alternative exists 1
• More established safety profile: Augmentin has decades of clinical use data compared to newer agents with limited lactation information 2

Important Caveats and Pitfalls to Avoid

Do not confuse pregnancy concerns with breastfeeding safety. 5 A 2001 study raised concerns about necrotizing enterocolitis when amoxicillin/clavulanic acid was given before preterm delivery, but:

• This concern applies only to use immediately before preterm delivery, not to postpartum breastfeeding 1, 5
• Subsequent studies did not confirm this risk 5
• For breastfeeding after term delivery, Augmentin remains fully compatible and safe 1, 2

Be aware that antibiotics in breast milk could theoretically cause falsely negative bacterial cultures if the infant develops fever requiring sepsis evaluation. 1 This is a diagnostic consideration, not a safety concern.

The safety profile assumes a healthy, full-term infant. 1 Additional caution may be warranted in premature infants or those with other medical conditions, though specific data are limited.

Practical Prescribing Guidance

Counsel mothers that: 2, 4

• Breastfeeding provides significant health benefits that outweigh the minimal risks of antibiotic exposure 6
• Minor changes in infant stool pattern are possible but not harmful 2, 4
• All observed adverse effects in studies were self-limiting and did not require stopping breastfeeding 4
• The small amounts of antibiotic in breast milk are not therapeutic for the infant—if the baby develops an infection, they require their own appropriate dosing 1

Do not recommend "pump and dump" or temporary cessation of breastfeeding when prescribing Augmentin. 1, 6 This outdated practice is not supported by current evidence and can disrupt the nursing relationship unnecessarily.