Abstract
Background
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.
Results
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.
Conclusion
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.
Similar content being viewed by others
References
Mylonas I, Dian D, Friese K (2005) Antibiotikatherapie in der Schwangerschaft. Gynakologe 38:761–770
Mylonas I, Friese K (2009) Infektionen in der Gynäkologien und Geburtshilfe. Elsevier Verlag/Urban & Fischer, München
Friese K, Schäfer A, Hof H (2002) Infektionen in der Gynäkologie und Geburtshilfe. Springer, Berlin
Friese K, Mörike K, Neumann G, Windorfer A (2009) Arzneimittel in der Schwangerschaft und Stillzeit: Ein Leitfaden für Ärzte und Apotheker Wissenschaftliche Verlagsgesellschaft mbH, Stuttgart
Friese K, Melchert F (2002) Arzneimitteltherapie in der Frauenheilkunde. Wissenschaftliche Verlagsgesellschaft mbH, Stuttgart
Briggs GG, Freeman RK, Yaffe SJ (1998) Drugs in pregnancy and lactation. Williams & Wilkins, Baltimore
Saunders EJ, Saunders JA (1990) Drug therapy in pregnancy: the lessons of diethylstilbestrol, thalidomide, and bendectin. Health Care Women Int 11:423–432
(2001) Erythromycin-induced pyloric stenosis in infants. Prescrire Int 10:16
Mahon BE, Rosenman MB, Kleiman MB (2001) Maternal and infant use of erythromycin and other macrolide antibiotics as risk factors for infantile hypertrophic pyloric stenosis. J Pediatr 139:380–384
Norgaard M, Skriver MV, Sorensen HT, Schonheyder HC, Pedersen L (2008) Risk of miscarriage for pregnant users of pivmecillinam: a population-based case–control study. APMIS 116:278–283
Sa del Fiol F, Gerenutti M, Groppo FC (2005) Antibiotics and pregnancy. Pharmazie 60:483–493
Amann U, Egen-Lappe V, Strunz-Lehner C, Hasford J (2006) Antibiotics in pregnancy: analysis of potential risks and determinants in a large German statutory sickness fund population. Pharmacoepidemiol Drug Saf 15:327–337
Bertsche T, Haas M, Oberwittler H, Haefeli WE, Walter-Sack I (2006) Drugs during pregnancy and breastfeeding: new risk categories—antibiotics as a model. Dtsch Med Wochenschr 131:1016–1022
Nahum GG, Uhl K, Kennedy DL (2006) Antibiotic use in pregnancy and lactation: what is and is not known about teratogenic and toxic risks. Obstet Gynecol 107:1120–1138
Haas A, Maschmeyer G (2008) Antibiotic therapy in pregnancy. Dtsch Med Wochenschr 133:511–515
Schäfer C, Spielman H (2001) Arzneimittelverordnung in Schwangerschaft und Stillzeit. Elsevier Urban und Fischer, Berlin, Jena
Dencker BB, Larsen H, Jensen ES, Schonheyder HC, Nielsen GL, Sorensen HT (2002) Birth outcome of 1886 pregnancies after exposure to phenoxymethylpenicillin in utero. Clin Microbiol Infect 8:196–201
Lewis DF, Adair CD, Robichaux AG, Jaekle RK, Moore JA, Evans AT, Fontenot MT (2003) Antibiotic therapy in preterm premature rupture of membranes: are seven days necessary? A preliminary, randomized clinical trial. Am J Obstet Gynecol 188:1413–1416 (discussion 1416–1417)
Czeizel AE, Rockenbauer M, Sorensen HT, Olsen J (2001) Augmentin treatment during pregnancy and the prevalence of congenital abnormalities: a population-based case–control teratologic study. Eur J Obstet Gynecol Reprod Biol 97:188–192
Sigg TR, Kuhn BR (2000) Inadvertent intrauterine infusion of ampicillin–sulbactam. Am J Health Syst Pharm 57:215
Simon C, Stille W (2000) Antibiotika—Therapie in Klinik und Praxis. Schattauer, Stuttgart
Garratty G, Leger RM, Arndt PA (1999) Severe immune hemolytic anemia associated with prophylactic use of cefotetan in obstetric and gynecologic procedures. Am J Obstet Gynecol 181:103–104
Berkovitch M, Segal-Socher I, Greenberg R, Bulkowshtein M, Arnon J, Merlob P, Or-Noy A (2000) First trimester exposure to cefuroxime: a prospective cohort study. Br J Clin Pharmacol 50:161–165
Czeizel AE, Rockenbauer M, Sorensen HT, Olsen J (2001) Use of cephalosporins during pregnancy and in the presence of congenital abnormalities: a population-based, case–control study. Am J Obstet Gynecol 184:1289–1296
Manka W, Solowiow R, Okrzeja D (2000) Assessment of infant development during an 18-month follow-up after treatment of infections in pregnant women with cefuroxime axetil. Drug Saf 22:83–88
Heikkila A, Erkkola R (1994) Review of β-lactam antibiotics in pregnancy. The need for adjustment of dosage schedules. Clin Pharmacokinet 27:49–62
Czeizel AE, Rockenbauer M, Sorensen HT, Olsen J (1999) A population-based case-control teratologic study of oral erythromycin treatment during pregnancy. Reprod Toxicol 13:531–536
Einarson A, Phillips E, Mawji F, D’Alimonte D, Schick B, Addis A, Mastroiacova P, Mazzone T, Matsui D, Koren G (1998) A prospective controlled multicentre study of clarithromycin in pregnancy. Am J Perinatol 15:523–525
Schick B, Hom M, Librizzi R, Donnenfeld A (1996) Pregnancy outcome following exposure to clarithromycin. Reprod Toxicol 10:162
Czeizel AE, Rockenbauer M, Olsen J, Sorensen HT (2000) A case–control teratological study of spiramycin, roxithromycin, oleandomycin and josamycin. Acta Obstet Gynecol Scand 79:234–237
Kallen BA, Otterblad Olausson P, Danielsson BR (2005) Is erythromycin therapy teratogenic in humans? Reprod Toxicol 20:209–214
Schardein JL (2000) Chemically induced birth defects. Marcel Dekker, New York
Lewis JH (1991) Drug hepatotoxicity in pregnancy. Eur J Gastroenterol Hepatol 3:883–891
Trexler MF, Fraser TG, Jones MP (1997) Fulminant pseudomembranous colitis caused clindamycin phosphate vaginal cream. Am J Gastroenterol 92:2113
Joesoef M, Schmid G (2002) Bacterial vaginosis. Clin Evid 1592–1600
Czeizel AE, Rockenbauer M, Olsen J, Sorensen HT (2000) A teratological study of aminoglycoside antibiotic treatment during pregnancy. Scand J Infect Dis 32:309–313
Freeman CD, Klutman NE, Lamp KC (1997) Metronidazole: a therapeutic review and update. Drugs 54:679–708
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 61:440
Thapa PB, Whitlock JA, Brockman Worrell KG, Gideon P, Mitchel EF, Roberson P, Pais R, Ray WA (1998) Prenatal exposure to metronidazole and risk of childhood cancer. Cancer 83:1461–1468
Beard CM, Noller KL, O’Fallon WM, Kurland LT, Dahlin DC (1988) Cancer after exposure to metronidazole. Mayo Clin Proc 63:147–153
Caro-Paton T, Carvajal A, Martin de Diego I, Martin-Arias LH, Alvares-Requejo A, Rodriguez-Pinilla E (1997) Is metronidazole teratogenic? A meta-analysis. Br J Clin Pharmacol 44:179–182
Czeizel AE, Rockenbauer M (1998) A population based case-control teratologic study of oral metronidazole treatment during pregnancy. Br J Obstet Gynaecol 105:2–7
Czeizel AE (1990) A case–control analysis of the teratogenic effects of co-trimoxazole. Reprod Toxicol 4:305–313
Heinonen OP, Slone D, Shapiro S (1977) Birth defects and drugs in pregnancy. Publishing Sciences Group, Littleton
Friese K, Hlobil H (1997) Prenatal toxoplasmosis: is screening in pregnancy necessary? Z Geburtshilfe Neonatol 201:115–120
Friese K (1994) Diagnosis and treatment of congenital toxoplasmosis. Geburtshilfe Und Frauenheilkunde 54:M99–M101
Wenk RE, Gebhardt FC, Bhagavan BS, Lustgarten JA, McCarthy EF (1981) Tetracycline-associated fatty liver of pregnancy, including possible pregnancy risk after chronic dermatologic use of tetracycline. J Reprod Med 26:135–141
Whalley PJ, Martin FG, Adams RH, Combes B (1970) Disposition of tetracycline by pregnant women with acute pyelonephritis. Obstet Gynecol 36:821–826
Czeizel AE, Rockenbauer M (2000) A population-based case–control study of oral oxytetracycline treatment during pregnancy. Eur J Obstet Gynecol Reprod Biol 88:27–33
Takayama S, Watanabe T, Akiyama Y, Ohura K, Harada S, Matsuhashi K, Mochida K, Yamashita N (1986) Reproductive toxicity of ofloxacin. Arzneimittelforschung 36:1244–1248
Gough AW, Kasali OB, Sigler RE, Baragi V (1992) Quinolone arthropathy acute toxicity to immature articular cartilage. Toxicol Pathol 20:436–449
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 69:83–89
Berkovitch M, Pastuszak A, Gazarian M, Lewis M, Koren G (1994) Safety of the new quinolones in pregnancy. Obstet Gynecol 84:535–538
Loebstein R, Addis A, Ho E, Andreou R et al (1998) Pregnancy outcome following gestational exposure to fluoroquinolones: a multicenter prospective controlled study. Antimicrob Agents Chemother 42:1336–1339
Holdiness MR (1987) Teratology of the antituberculosis drugs. Early Hum Dev 15:61–74
Acknowledgments
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.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Mylonas, I. Antibiotic chemotherapy during pregnancy and lactation period: aspects for consideration. Arch Gynecol Obstet 283, 7–18 (2011). https://doi.org/10.1007/s00404-010-1646-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00404-010-1646-3