Antimicrobials in pregnancy
From IDWiki
Principles
- Use medications only if absolutely necessary
- If possible, avoid therapy during the first trimester
- Use a safe medication
- Use the narrowest spectrum and shortest course
- When possible, use a single agent
Specific Antimicrobials
Generally considered safe in pregnancy:
- Penicillins, including amoxicillin, ampicillin
- Cephalosporins, including cefaclor, cephalexin, although they have been associated with kernicterus (ceftriaoxone)
- Azithromycin, which is preferred to erythromycin and clindamycin
- Vancomycin, daptomycin, fidaxomicin
- Nitrofurantoin, although it has been associated with orofacial clefts including cleft lip and cleft palate
- Metronidazole, though topical should be avoided
- Fosfomycin
Avoid unless benefits outweight risks:
- Fluoroquinolones, based on animal data of bone and cartilage damage
- Linezolid
- Polymixins
- Cotrimoxazole: avoid in first trimester (congenital malformations), and after 32 weeks (risk of kernicterus); has been associated with diaphragmatic hernia and esophageal atresia
Should be avoided altogether:
- Tigecycline
- Aminoglycosides: streptomycin associated with hearing loss, while others may be used for short courses
- Tetracyclines can discolor a developing baby's teeth and aren't recommended after the 15th week of pregnancy
Further Reading
- A Review of Antibiotic Use in Pregnancy. Pharmacotherapy. 2015;35(11):1052-62. doi: 10.1002/phar.1649
