The Safety of using Amoxicillin while Breastfeeding

Being a mom is really a top of the world feeling. You get to play with your child that you had been dying to hold in hands for the whole 9 months of pregnancy.

You may also be concerned about the health of the infant, especially if you’re ill and taking any prescription medicine.

Most of the drugs are safe to take while lactating but it is advised to consult your doctor before starting any.

What is amoxicillin and why is it prescribed?

Amoxicillin is a broad spectrum semi-synthetic antibiotic of penicillin family.

It is used to treat a variety of bacterial infections including strep throat, sinusitis, abscesses, skin infections, tonsillitis, typhoid, pneumonia etc. Amoxicillin blocks bacterial cell wall synthesis thereby halting their growth [1].

It is available in both capsule and injectable form. A doctor might prescribe you amoxicillin after taking tissue samples for susceptibility of bacteria against this drug and also after making sure that you don’t have a history of penicillin allergy.

Mastitis is the inflammation of breast tissue caused by bacterial infection and is more common in a breastfeeding woman. Nipples are prone to cracks during suckling and bacteria can gain entry through them.

However, it can occur in any woman, even if she is not breastfeeding. Amoxicillin combined with clavulanic acid is the treatment of choice in such cases.

The most common side effect of amoxicillin is the development of itchy rash in certain people.

Stop taking the drug and consult your doctor immediately if you have a skin rash, swelling of the tongue, throat or face, or breathing difficulties while taking amoxicillin.

Other side effects include nausea, itching, hives, opportunistic infections, a flare-up of allergies and diarrhea.

Is amoxicillin secreted in breast milk?

Yes. Amoxicillin gets secreted in the milk of a breastfeeding woman in minute concentration that is not expected to cause any harmful effect in infants.

The dosage of Amoxicillin used to treat infections in the newborn is many times higher than that present in breast milk of a woman taking a standard dose for treating bacterial infections.

According to research [2], the maximum concentration of amoxicillin reaches after 4-5 hours of a loading dose of 1 gram.

An infant would receive a maximum daily dose of 0.1mg/kg body weight if the mother takes 500mg amoxicillin t.i.d. (thrice a day). This is equal to around 0.25 to 0.5% of a typical infant amoxicillin dosage.

How safe is it to take amoxicillin during breastfeeding?

In general, all antibiotics can cause adverse reactions in nursing infants. They can cause unbalance of gut flora which can result in malabsorption and diarrhea.

They can also activate the immune system due to their “foreign” nature, the effects of which may or may not be dose related. Based on these facts, antibiotics can be classified into three groups:

Those that are safe to be taken by lactating mothers.
Those whose effects in breastfed infants are not known and should be prescribed with caution.
Those that are contraindicated for breastfeeding mothers.

Amoxicillin is considered the safest antibiotic for a lactating mother [3].

The research shows that the health of the nursed infant is not affected if the mother is taking the drug [4]. However, it is not entirely free of side-effects.

Effect of amoxicillin on breastfed baby

The side-effects of amoxicillin are due to the active compound penicillin present in it. The baby’s immune system recognizes it as a foreign substance and mounts an immune response to it.

The inflammatory mediators are released causing diarrhea and rash in susceptible newborn [5].

Although such low amoxicillin concentration is very unlikely to have any side-effects in nursing infants; it still can affect gut bacteria and cause diarrhea.

The side effects have a really low probability of occurrence but as a mom, you must be worried about the possible side effects. These include:

Diarrhea
Vomiting
Furring of tongue
Skin rash
Diaper rash
Drowsiness
Change in stool frequency and/or consistency
Change in sleeping or feeding schedule

But these side effects are infrequent and do not require any treatment.

In a prospective study, mothers taking amoxicillin and clavulanic acid regimen had their infants monitored for adverse effects including diarrhea, reluctant to feed, skin rash, weight change, and jaundice.

There was no statistical difference found when compared with the infants of mothers not taking any antibiotics and those of mothers taking the related antibiotics [6].

But make sure not to take amoxicillin without the prescription of a doctor while you’re pregnant or breastfeeding.

If your child develops any aforementioned side effects, discontinue the drug and let your physician/pediatrician know if you ever took this medicine.

What to do if your baby develops amoxicillin side effects?

Although the chance of your baby developing adverse drug reactions is rare, if that happens you should:

Stop taking the drug:

If you notice a change in infant’s bowel habit or any rash on the skin, stop taking the prescribed antibiotics and do not do any intervention to treat the infant at home.

The rash will subside with time and bowel motility will return to normal.

Consult a doctor:

Let the doctor know you’re breastfeeding in the first place, whenever you get any prescription antibiotics.

In case of any drug reaction in infant, the doctor may ask you the time of rash onset, relation with breastfeeding, the frequency of breastfeeding and other relevant questions.

He may change the dose of amoxicillin or prescribe you another safer antibiotic.

Breastfeeding before taking amoxicillin:

Amoxicillin is safe for lactating mothers, but you can further satisfy yourself by feeding your infant before taking the dose.

Although this can only be done if you’re taking a single dose per day, it works to minimize the risk of probable side effects.

Switch to formula milk:

Your doctor might prescribe you formula milk until the illness, for which you’re taking antibiotics, goes away.

But note that formula milk can also cause allergic reactions in some infants. Cow milk is also a good substitute if your baby is older than 1 year and not intolerant to cow-milk proteins.

A mother can continue to take amoxicillin and clavulanic acid without posing any threat to health of baby. Sticking to antibiotics regimen and being vigilant for any symptoms of side effects will result in better health outcome for both the mother and the baby.

References

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