Antibiotic chemotherapy during pregnancy and lactation period: aspects for consideration
- 1.3k Downloads
Infections during gestation, delivery and the postnatal period can jeopardise not only the mother, but also the child. Along with chromosomal abnormalities and immunological diseases, infection in early pregnancy represents the most important reason for abortion. During the second and third trimester, infections are the principal cause for preterm labour, premature membrane rupture, premature delivery and the resultant complications in the newborn child. Many pregnant women are very cautious about taking antibiotics due to primarily potentially detrimental effects on the unborn child. However, there are no contraindications for antibiotic treatment during pregnancy in the event of a serious infectious disease of the mother.
Materials and methods
In this review the indications and contraindications of the administration of antibiotics during pregnancy are being reviewed.
Penicillins are a first-line antibiotic treatment during pregnancy, with the exception of cases in which there is a maternal allergy to penicillin. Cephalosporins are another first-line antibiotic used during pregnancy. In principle, more commonly used cephalosporins should be given priority. Owing to associated nephrotoxicity and ototoxicity, aminoglycosides should not be prescribed at any time during pregnancy. Systematic use of aminoglycosides should be considered solely in the event of life-threatening infections with gram-negative pathogens and/or treatment failure of recommended antibiotics during pregnancy. The use of metronidazole is also permitted during pregnancy, provided the indications for its use have been strictly verified. Lincosamides should be used only if penicillins, cephalosporins and erythromycin have failed to eradicate infection. Sulfonamides, trimethoprim and cotrimoxazole are second-line agents for the use during pregnancy. Tetracyclines should not be administered to pregnant women after the fifth week of pregnancy, and are deemed contraindicated. As a precautionary measure, gyrase inhibitors are also contraindicated for pregnant women, children and young adolescents.
On the basis of our current state of knowledge, the vast majority of antibiotics do not cause serious harm to the unborn child if used properly and at the appropriate doses during pregnancy. The treatment with an antibiotic that is contraindicated does not justify termination of pregnancy. However, ultimately no medicine, including antibiotics, can be described as absolutely safe.
KeywordsPregnancy Antibiotics Treatment Contraindication Adverse outcome
The author would like to thank Prof. Dr. E.-R. Weissenbacher and Prof. Dr. K. Friese for their helpful discussion regarding antibiotic treatment during pregnancy and lactation period. The author does not have any financial, personal, political, intellectual or religious interests in publishing this article.
- 2.Mylonas I, Friese K (2009) Infektionen in der Gynäkologien und Geburtshilfe. Elsevier Verlag/Urban & Fischer, MünchenGoogle Scholar
- 3.Friese K, Schäfer A, Hof H (2002) Infektionen in der Gynäkologie und Geburtshilfe. Springer, BerlinGoogle Scholar
- 4.Friese K, Mörike K, Neumann G, Windorfer A (2009) Arzneimittel in der Schwangerschaft und Stillzeit: Ein Leitfaden für Ärzte und Apotheker Wissenschaftliche Verlagsgesellschaft mbH, StuttgartGoogle Scholar
- 5.Friese K, Melchert F (2002) Arzneimitteltherapie in der Frauenheilkunde. Wissenschaftliche Verlagsgesellschaft mbH, StuttgartGoogle Scholar
- 6.Briggs GG, Freeman RK, Yaffe SJ (1998) Drugs in pregnancy and lactation. Williams & Wilkins, BaltimoreGoogle Scholar
- 8.(2001) Erythromycin-induced pyloric stenosis in infants. Prescrire Int 10:16Google Scholar
- 16.Schäfer C, Spielman H (2001) Arzneimittelverordnung in Schwangerschaft und Stillzeit. Elsevier Urban und Fischer, Berlin, JenaGoogle Scholar
- 21.Simon C, Stille W (2000) Antibiotika—Therapie in Klinik und Praxis. Schattauer, StuttgartGoogle Scholar
- 29.Schick B, Hom M, Librizzi R, Donnenfeld A (1996) Pregnancy outcome following exposure to clarithromycin. Reprod Toxicol 10:162Google Scholar
- 32.Schardein JL (2000) Chemically induced birth defects. Marcel Dekker, New YorkGoogle Scholar
- 33.Lewis JH (1991) Drug hepatotoxicity in pregnancy. Eur J Gastroenterol Hepatol 3:883–891Google Scholar
- 34.Trexler MF, Fraser TG, Jones MP (1997) Fulminant pseudomembranous colitis caused clindamycin phosphate vaginal cream. Am J Gastroenterol 92:2113Google Scholar
- 35.Joesoef M, Schmid G (2002) Bacterial vaginosis. Clin Evid 1592–1600Google Scholar
- 38.Diav-Citrin O, Gotteiner T, Shechtman S, Arnon J, Ornoy A (2000) Pregnancy outcome following gestational exposure to metronidazole: a prospective controlled cohort study (abstract). Teratology 61:440Google Scholar
- 42.Czeizel AE, Rockenbauer M (1998) A population based case-control teratologic study of oral metronidazole treatment during pregnancy. Br J Obstet Gynaecol 105:2–7Google Scholar
- 44.Heinonen OP, Slone D, Shapiro S (1977) Birth defects and drugs in pregnancy. Publishing Sciences Group, LittletonGoogle Scholar
- 52.Schaefer C, Amoura-Elefant E, Vial T, Ornoy A, Garbis H, Robert E, Rodriguez-Pinilla E, Pexieder T, Prapas N, Merlob P (1996) Pregnancy outcome after prenatal quinolone exposure. Evaluation of a case registry of the European Network of Teratology Information Services (ENTIS). Eur J Obstet Gynecol Reprod Biol 69:83–89CrossRefPubMedGoogle Scholar