Professional Documents
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Selection of Antibiotics in Pregnancy
Selection of Antibiotics in Pregnancy
Selection of Antibiotics in Pregnancy
OBSTETRICS
Antibiotic
Definition:
Chemical produced by a microorganism
that kills or inhibits the growth of another
microorganism
OBJECTIVES
Use only drugs which are extensively used in past
Do not use new or untried drug
Use smallest effective dose
No drug is safe beyond all doubts in early pregnancy
Recognize factors which determine drug passage
across the placenta and into breast milk.
Identify aspects of medications that determine safety
during lactation.
GENERAL CONSIDERATIONS IN
OBSTETRICS
TRIMESTER FIRST
LACTATION
Timing of exposure
Developmental stage during exposure
Maternal dose and duration
Maternal pharmacokinetics
Genetic factors/phenotypes
Interactions between agents
Known Teratogenic Antibiotics
Aminoglycosides
Streptomycin
Polymyxins
Colistin
Gentamycin
Polymyxin
Tobramycin etc.
Tetracyclines Antimycotics
Amphoteracin B
Doxycycline
5 flucytosine
Minocycline
Grisiofulvin etc.
Tetracycline
5- nitroimidazoles
Metronidazole etc.
ANTIBIOTICS
Beta Lactams -Penicillins
-Cephalosporins
-Carbepenems
-Monobactams
Flouroquinolones
Tetracyclines & Chloramphenicol
Macrolides
Aminoglycosides
Sulfonamides
Miscellaneous Antibiotics
Penicillins
Active against gram positive bacteria newer penicillin
active against both gram positive and gram negative
bacteria.
In Pregnancy:
Category B drugs
Cross the placenta easily and rapidly
Lactation:
Crosses in low concentrations
Compatible with breastfeeding
May cause diarrhea in neonates
I. Narrow-spectrum:
II. Moderate-spectrum:
A. β-lactamase sensitive:
amoxicillin
benzathine penicillin
Ampicillin
benzylpenicillin(penicillin G)
Phenoxymethylpenicillin III. Broad-spectrum
(penicillin V) co-amoxiclav
procaine penicillin (amoxicillin+clavulanic acid)
IV. Extended-spectrum
B. Penicillinase-resistant azlocillin
penicillins: carbenicillin
methicillin ticarcillin
oxacillin mezlocillin
nafcillin piperacillin
cloxacillin
dicloxacillin
flucloxacillin
C. β-lactamase-resistant
penicillins:
Temocillin
Penicillin
These group of drugs belong to category B
Considered safe in pregnancy
No drug so far has been found to have any effect on rat
fetus.
Cephalosporins
In Pregnancy:
Category B drugs
Cross the placenta during pregnancy
Some reports of increased anomalies with specific
cephalosporins (cephalexin, cephradrine)
Primarily cardiac defects….
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Lactation:
Excreted into breastmilk in low concentrations
Considered compatible with breastfeeding
Classifications of Cephalosporins
First Generation:
Cephalexin
Cefazolin
Cephalothin
Cephradine
Ceftriaxone
Cefotaxime
Cetazidime
Cefoperazone
Cefixime
Cefipime:
Active against G+ bacteria than cefazolin against s.
pyogenes, s.pneumoniae but lower against s. aureus.
Similar to cefotaxime against E.coli & K. pneumoniae
but for p. aeruginosa
Carbapenems
Aztreonam
Tigemonam
Nocardicin
A.tabtoxinine-β-lactam
Pregnancy Category B, likely safe in pregnancy, little
human data
Lactation – Compatible
Fluoroquinolones
Clindamycin
Pregnancy Category B, commonly used
Lactation – Compatible per AAP
Miscellaneous Antibiotics
Linezolid
Pregnancy Category C, no human data available
Lactation – unknown, myelosuppression in animals
Vancomycin
Pregnancy Category B, compatible
Lactation – likely compatible, not absorbed
Miscellaneous Antibiotics
Nitrofurantoin
Pregnancy Category B, possible hemolytic anemia with
use at term
Low levels of glutathione may predispose the fetus to
haemolytic anaemia if it is exposed to nitrofurantoin
Lactation – Compatible, avoid with G-6-PD deficiency
Trimethoprim
Pregnancy Category C, potentially problematic early in
pregnancy
Lactation – Compatible as combination drug
Miscellaneous Antibiotics
Metronidazole:
Pregnancy Category C, carcinogenic in animals, avoid in
1st trimester if possible
Causes ongenital malformations including coronal
hypospadias, syndactyly, calcaneous valgus, hydrocele
and pyloric stenosis, which may not necessarily be
related to the first trimester.
Lactation – may cause lactose intolerance, and since the
drug may be teratogenic.Low dose 200-400mg TDS can
be given.
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Topical Antibiotics
3. Not recommended:
Metronidazole (single high
dose).
Quinolones
Chloramphenicol.
DRUGS WITH ADVERSE EFFECTS ON FETUS
Chloramphenicol:
Gray baby syndrome
In women or fetuses with glucose-6-phosphate
dehydrogenase (G6PD) deficiency, the breakdown of red
blood cells
Fluoroquinolones:
Possibility of joint abnormalities (seen only in animals)
Kanamycin:
Damage to the fetus's ear, resulting in deafness
Nitrofurantoin:
In women or fetuses with G6PD deficiency, the breakdown
of red blood cells
contd
Streptomycin:
Damage to the fetus's ear, resulting in deafness
Sulfonamides:
When the drugs are given late in pregnancy, jaundice
and possibly brain damage in the newborn
(sulfasalazine)
In women or fetuses with G6PD deficiency, the
breakdown of red blood cells
Tetracycline:
Slowed bone growth, permanent yellowing of the teeth,
and increased susceptibility to cavities in the baby
Occasionally, liver failure in the pregnant woman
Questions to Ask
Is this drug used in neonates?
How old is the infant?
What is the duration of therapy?
What are the pharmacokinetics of the agent?
What is the risk/benefit for the mother?
Does this medicine cause problems in G6PD
deficiency?
Considerations in Breastfeeding
Increased cost
of treatment
Conclusions
No antibiotic is safe beyond all doubts in early pregnancy