Infectious Disease Book

Immunization

Pharmacology

  • Antibiotics in Pregnancy

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Antibiotics in PregnancyAka: Antifungal Medications in Pregnancy, Antiparasitic Medications in Pregnancy, Antiviral Medications in Pregnancy

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  1. See Also
    1. Vaccination in Pregnancy
    2. Medications in Pregnancy
    3. Acute Cystitis in Pregnancy
    4. Pyelonephritis in Pregnancy
    5. HIV in Pregnancy
  2. Class B: No risk in controlled animal studies
    1. Antifungal Topical Agents
      1. Nystatin (Mycostatin)
    2. Antiparasitic agents
      1. Metronidazole or Flagyl (after first Trimester)
        1. Avoid single dose therapy
      2. Praziquantel - not in Briggs
      3. Permethrin (topical) - not in Briggs (1998)
    3. Anti-Tuberculosis agents
      1. Ethambutol
      2. Didanosine - not in Briggs (1998)
    4. Antiviral agents
      1. Nelfinavir - not in Briggs (1998)
      2. Ritonavir
      3. Saquinavir
      4. Famciclovir
      5. Valacyclovir
    5. Antibiotics
      1. All Cephalosporin Antibiotics (except Moxalactam)
      2. All Erythromycin except Erythromycin Estolate
      3. Azithromycin (Zithromax)
      4. All Penicillin Antibiotics
      5. Clindamycin
      6. Macrodantin (before third trimester)
      7. Sulfa antibiotics (before third trimester)
  3. Class C: Small risk in controlled animal studies
    1. Antifungal agents
      1. CDC recommends only Topical Antifungal in pregnancy
        1. Avoid Antifungals in first trimester if possible
      2. Terbinafine (Lamisil) - not in Briggs (1998)
      3. Clotrimazole (Mycelex, Lotrimin)
      4. Butoconazole (Femstat)
      5. Miconazole (Monistat)
      6. Amphotericin B
      7. Fluconazole (Diflucan)
        1. No fetal adverse effects seen in one study
        2. King (1998) Clin Infect Dis 27:1151
      8. Itraconazole (Sporanox)
      9. Ketoconazole (Nizoral)
        1. Teratogenic and Embryotoxic in animals
      10. Griseofulvin
        1. Teratogenic and Embryotoxic in animals
    2. Antimalarial agents
      1. Mefloquine (Lariam)
      2. Chloroquine
      3. Primaquine
    3. Antiparasitic agents
      1. Albendazole - not in Briggs (1998)
      2. Ivermectin - not in Briggs (1998)
      3. Mebendazole
      4. Pentamidine
      5. Thiabendazole
      6. Pyrantel
    4. Anti-Tuberculosis agents
      1. Dapsone
      2. Isoniazid (INH)
      3. Pyrazinamide
      4. Rifampin
    5. Antiviral agents
      1. Lamivudine
      2. Stavudine
      3. Zalcitabine
      4. Zidovudine
      5. Delavirdine - not in Briggs (1998)
      6. Nevirapine
      7. Indinavir
      8. Cidofovir
      9. Foscarnet
      10. Ganciclovir
      11. Acyclovir
      12. Amantadine
      13. Rimantadine
      14. Interferon alpha
    6. Antibiotics
      1. Imipenem-Cilastin
      2. All Fluoroquinolone antibiotics
      3. Clarithromycin (Biaxin)
      4. Pediazole - not in Briggs (1998)
      5. Sulfisoxazole - not in Briggs (1998)
      6. Trimethoprim
      7. Vancomycin
      8. Chloramphenicol
      9. Gentamicin
  4. Class D: Strong evidence of risk to the human fetus
    1. Antiparasitic agents
      1. Metronidazole or Flagyl (First Trimester)
        1. New evidence suggests first trimester safety
        2. Burtin (1995) Am J Obstet Gynecol 172:525
    2. Antibiotics
      1. Amikacin (Class D per manufacturer)
      2. Kanamycin
      3. Streptomycin
      4. Tobramycin (Class D per manufacturer)
      5. Sulfa (Third Trimester)
      6. All Tetracycline antibiotics
        1. Doxycycline
        2. Tetracycline
        3. Minocycline
      7. Erythromycin Estolate (llosone)
        1. Due to hepatotoxicity in pregnant women
        2. McCormack (1977) Antimicrob Agents Chemother 12:630
      8. Macrobid and Nitrofurantoin (Third Trimester)
        1. Do not use either of these past 38 weeks
        2. Can cause Hemolytic Anemia in newborns
        3. Related to immature liver and G6PD Deficiency
    3. Vaccines
      1. Yellow Fever Vaccine
  5. Class X: Very high risk to the human fetus
    1. Antimalarial agents
      1. Quinine
    2. Antiviral agents
      1. Ribavirin
      2. Rebetron - not in Briggs (1998)
    3. Vaccines
      1. Measles Vaccine
      2. Mumps Vaccine
      3. Rubella Vaccine
      4. Small Pox Vaccine
      5. TC-83 Venezuelan Equine Encephalitis Vaccine
      6. Varicella Vaccine
        1. Risk if vaccinated within 4 weeks of conception
        2. Theoretic risk only; not an indication for EAB
  6. References
    1. Briggs (1998) Drugs in Pregnancy and Lactation, 5th ed
    2. Black (2003) Am Fam Physician 67(12):2517
    3. Larimore (2000) Prim Care 27(1):35

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