Which Antibiotics Are Safe During Pregnancy?

Which Antibiotics Are Safe During Pregnancy
Is it safe to take antibiotics during pregnancy? – Answer From Mary Marnach, M.D. Antibiotics are commonly prescribed during pregnancy. However, the specific type of medication must be chosen carefully. Some antibiotics are OK to take during pregnancy, while others are not.

  • Penicillins, including amoxicillin (Amoxil, Larotid) and ampicillin
  • Cephalosporins, including cefaclor and cephalexin (Keflex)
  • Clindamycin (Cleocin, Clinda-Derm, Clindagel)

Certain other antibiotics are believed to pose risks during pregnancy. For example, tetracyclines can affect bone development and discolor a developing baby’s teeth. Tetracyclines aren’t recommended for use after the fifth week of pregnancy. Sulfonamides might pose a small risk of heart conditions, cleft lip or palate, and jaundice.
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Which antibiotics Cannot be used in pregnancy?

Journal List Rev Obstet Gynecol v.2(3); Summer 2009 PMC2760892

Rev Obstet Gynecol.2009 Summer; 2(3): 135–136. The question of whether to prescribe a course of antibiotics to a pregnant woman is a dilemma faced by obstetrics-gynecology (ob-gyn) care providers on a daily basis. In appropriate circumstances-such as the treatment of asymptomatic bacteriuria to prevent ascending infection and pyelonephritis-related adverse pregnancy outcomes-antibiotic therapy can be both effective and life saving.

As with the administration of other medications, the potential benefits need to be weighed against the risk to the fetus. Some antibiotics are known to be teratogenic and should be avoided entirely during pregnancy. These include streptomycin and kanamycin (which may cause hearing loss) and tetracycline (which can lead to weakening, hypoplasia, and discoloration of long bones and teeth).

How about other antibiotics? Are they safe? Can they be given with impunity? A decade ago, a number of well-designed clinical trials 1, 2 and systematic reviews 3 concluded that broad-spectrum antibiotics can prolong the latency period (interval to delivery) and improve short-term perinatal outcome in pregnancies complicated by preterm premature rupture of membranes (pPROM) prior to 34 weeks of gestation, but not in women with preterm labor and intact membranes.

Seven-year follow-up of the fetuses exposed to these antibiotics was recently published.4, 5 Reassuringly, broad-spectrum antibiotics given to fetuses in the setting of pPROM were not associated with any long-term disadvantage, although it is concerning to note that the short-term benefits in perinatal outcome described in the original report 1 did not appear to persist to age 7.4 Even more concerning, however, was the observation that fetuses exposed to broad-spectrum antibiotics in the setting of intact membranes were at significantly higher risk of cerebral palsy at age 7 (erythromycin, odds ratio 1.93; 95% confidence interval, 1.21–3.09; co-amoxiclav, OR 1.69; 95% CI, 1.07–2.67).5 The risk was even higher when both antibiotics were given together (4.55% incidence of cerebral palsy compared with 1.97% for co-amoxiclav alone, 2.29% for erythromycin alone, and 1.63% for placebo).5 Exposure to co-amoxiclav was also associated with an increased risk of necrotizing enterocolitis.5 The mechanism of injury is not clear.

The most likely explanation is an antibiotic-mediated suppression of infection and preterm birth, thereby causing the fetus to remain in a hostile proinflammatory intrauterine environment for a longer period of time. However, a direct injurious effect of the antibiotic itself cannot be excluded.

Indeed, 1 reason why a significant association between antibiotics and cerebral palsy was observed with intact membranes but not in the setting of pPROM may have to do with the dose and/or duration of antibiotic exposure. Because the vast majority of women in the preterm labor and intact membrane study did not deliver within 48 hours (89.9%) or 7 days (84.6%) of enrollment, their fetuses were more likely to be exposed to the full 10-day course of antibiotic therapy.2 In contrast, 30% to 40% of women in the pPROM study delivered within 48 hours and 55% to 60% within 7 days.

As such, these fetuses were exposed to antibiotics for a far shorter period of time.1 An additional adverse effect of the increased use of broad-spectrum antibiotics in the setting of pPROM is an increase in antibiotic resistance, especially erythromycin-resistant Group B β-hemolytic streptococcus (GBS).

The debate about the efficacy and safety of antibiotics in pregnancy must be seen in a larger context. It highlights the philosophical difference between 2 distinct groups of obgyn care providers: those who believe that everything possible should be offered in a given clinical setting in the hope that something will help (also known as the we don’t have all the information we need or the might as well give it, it won’t do any harm group) and those who hold out against popular opinion until there is consistent and compelling scientific evidence that an individual course of action is beneficial and has a favorable risk-to-benefit ratio (the so-called therapeutic nihilists ).

As protagonists of the latter camp, we offer the following suggestions to ob-gyn care providers faced with the dilemma of whether to prescribe a medication to a pregnant woman:

Use medications only if absolutely indicated, For antibiotics, this includes treatment of confirmed infection (urinary tract infection, pyelonephritis, appendicitis, cholecystitis, chorioamnionitis), prevention of ascending infection (asymptomatic bacteriuria), and prevention of early-onset neonatal GBS sepsis. If possible, avoid initiating therapy during the first trimester, This is the period of fetal structural development and therefore the highest risk for iatrogenic teratogenicity. Select a safe medication, which often means an older drug with a proven track record in pregnancy. Certain antibiotics (streptomycin, kanamycin, tetracycline) are best avoided entirely in pregnancy because of their teratogenicity. Wherever possible, single-agent therapy is preferred over polypharmacy, Moreover, narrow-spectrum antibiotics are preferred over those with a broad spectrum for the treatment of established infection and intrapartum GBS chemoprophylaxis. The exception is the use of empiric broad-spectrum antibiotics to prolong latency in the setting of pPROM remote from term (discussed above). Use the lowest effective dose. Discourage the use of over-the-counter drugs, which may interfere with the efficacy and/or metabolism of prescription medications.

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Is amoxicillin 500mg safe in pregnancy?

What if I have already taken amoxicillin, co-amoxiclav, or penicillin V during pregnancy? – Amoxicillin, co-amoxiclav, and penicillin V are often used in pregnancy and would not be expected to harm a baby in the womb. However, if you are pregnant and have taken any medicines it is always a good idea to let your doctor know in case you need any additional monitoring or treatment.
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When can a pregnant woman take antibiotics?

A Word From Verywell – While UTIs and respiratory illnesses during pregnancy are tough, the silver lining is that treating them with antibiotics is considered safe for you and your unborn baby. It’s important to remember that if the risk to your baby is greater from leaving a bacterial infection untreated, an antibiotic is likely the best option.
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Is azithromycin safe in pregnancy?

Azithromycin and pregnancy – Azithromycin is generally thought to be OK to take during pregnancy if you have an infection that needs treatment. However, other antibiotics may be more suitable for you, depending on your type of infection. Talk to your doctor about taking azithromycin as it should only be taken if the benefits outweigh the possible risks.
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What is the safest antibiotic?

Saving Lives, Yet Not Without Risk – Antibiotics are one of the great medical advances of the 20th century. But their power — like all medications — comes with a risk of side effects. Penicillins are the oldest of the antibiotics and are generally safe (but they can cause side effects such as diarrhea, skin rash, fever and more).

  • FQs are the newest group of antibiotics.
  • They include ciprofloxin, levofloxacin and several others that all end in “floxin.” All of these antibiotics carry “black box” warnings — the most serious caution that the FDA has — about possible tendon rupture, permanent nerve damage and risk of worsening myasthenia gravis, a neuromuscular and autoimmune disease.
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Here is a good article on the various categories of antibiotics and their uses. “The FDA said the risk of tendinitis and tendon rupture was higher in people aged over 60, patients who had received kidney, heart or lung transplants, and people taking steroid treatment,” according to a 2008 article in BMJ.
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Can antibiotics harm a fetus?

During pregnancy, babies get their oxygen, blood, and nutrients through an organ called the placenta, This organ acts as a filter for your baby, but some medicines can also pass through it and affect how your baby grows. This is why pregnant women have lots of instructions to be careful with medicine, remedies, and over-the-counter drugs.
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Can amoxicillin cause birth defects?

The Full Story – Antibiotics are some of the most frequently prescribed drugs for pregnant women. Amoxicillin is an antibiotic that is very similar to penicillin. It works by blocking bacterial cell wall production, leading to cell breakdown and bacterial death.

Amoxicillin is often prescribed for the treatment of respiratory and urinary tract infections and is frequently prescribed to pregnant women for treatment of these conditions. While amoxicillin is often assumed to be safe in pregnancy, it does transfer from the mother’s bloodstream to the placenta, and therefore it is important to recognize the potential risks associated with the use of amoxicillin in pregnancy.

Amoxicillin is classified by the United States Food and Drug Administration (FDA) as Pregnancy Category B. This means that multiple studies of the use of amoxicillin in pregnant animals have not shown fetal harm to occur after the mother takes amoxicillin, but there are not adequate or well-controlled studies of the use of amoxicillin in pregnant women.

  1. In animal studies, the use of amoxicillin at doses up to 10 times the standard human dose was not associated with reproductive harm.
  2. A few human studies found that amoxicillin might be associated with birth defects, specifically cleft palate, when used in the first trimester of pregnancy during the period of fetal organ development.

Multiple other human studies have not demonstrated any harmful effects of amoxicillin on fetal development. Amoxicillin is often prescribed in combination with another antibiotic called clavulanic acid. Clavulanic acid prevents amoxicillin from being broken down by certain enzymes, making this combination of drugs more effective against resistant bacteria than amoxicillin alone.

  • The combination of amoxicillin and clavulanic acid is known as Augmentin®.
  • Like amoxicillin, there are scant data suggesting that the use of clavulanic acid in pregnancy is harmful to the fetus.
  • Overall, the use of amoxicillin, with or without clavulanic acid, can be considered as generally safe in pregnant women.

If a woman takes amoxicillin before realizing that she is pregnant, there is likely nothing to worry about in terms of fetal health and safety. The health and development of a fetus is largely dependent on its mother, so it’s very important for pregnant women and women of childbearing age to stay as healthy as possible.

Sometimes, this may include taking antibiotics like amoxicillin. Amoxicillin is also safe to use in women who are breastfeeding. Its physical characteristics, including low fat solubility, low protein binding, and acidic pH, limit its transfer into breastmilk. The American Academy of Pediatrics considers this drug to be safe to take when breastfeeding.

All drugs, including prescription medications, can cause unwanted and potentially dangerous side effects. Augmentin can rarely cause liver injury. In one study, an infant whose mother took Augmentin was noted to have abnormally high liver enzymes. The infant’s liver enzymes returned to normal after the mother stopped taking Augmentin.

Both amoxicillin and Augmentin are also known to cause allergic reactions, including anaphylaxis, in susceptible individuals. Since the antibodies that cause anaphylaxis do not cross the placental barrier, the development of anaphylaxis in a fetus is extremely unlikely to occur. However, maternal anaphylaxis can cause abnormal blood flow to the uterus or womb.

This can affect the fetus and result in brain swelling, neurological damage, and fetal death. If you suspect an adverse reaction after taking amoxicillin, get an immediate personalized recommendation online or call Poison Control at 1-800-222-1222. Both options are free, confidential, and available 24 hours a day.
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Is paracetamol safe in pregnancy?

Pregnancy, breastfeeding and fertility while taking paracetamol for adults Paracetamol is the first choice of painkiller if you’re pregnant. It is commonly taken during pregnancy and does not harm your baby.
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Is ciprofloxacin safe in pregnancy?

Ciprofloxacin is approved for prophylaxis following inhalational anthrax exposure 1, According to the Centers for Disease Control and Prevention (CDC), ciprofloxacin (500 mg, orally, two times a day for 60 days) is the antibiotic of choice for initial prophylactic therapy among asymptomatic pregnant women exposed to Bacillus anthracis,

In instances where the specific B. anthracis strain has been shown to be penicillin-sensitive, prophylactic therapy with amoxicillin (500 mg, orally, three times a day for 60 days) may be considered 2, CDC guidelines for treatment of anthrax infection in pregnant women recommend either ciprofloxacin or doxycycline with one or two other antibiotics added for inhalational anthrax or systemic involvement 3,

While there are no controlled studies of ciprofloxacin use in pregnant women to show safety, an expert review of published data on experiences with ciprofloxacin use during pregnancy by TERIS – the Teratogen Information System – concluded that therapeutic doses during pregnancy are unlikely to pose a substantial teratogenic risk (quantity and quality of data = fair), but the data are insufficient to state that there is no risk 4,

However, there are no human data available to assess the effects of long-term therapy in pregnant women such as that proposed for treatment of anthrax exposure. Ciprofloxacin is excreted into breast milk but is considered as “usually compatible with breastfeeding” by the American Academy of Pediatrics.5 Background: The association between fluoroquinolones and arthropathy, although observed in immature animals and rarely reported in humans, has resulted in the restricted use of fluoroquinolones during pregnancy.

Young dogs given ciprofloxacin developed arthropathy with permanent cartilage erosion in weight-bearing joints. Similar arthropathies have been reported in neonatal mice 6, Transient arthropathy has been reported in a small number of patients with cystic fibrosis 7, 8

Arthropathy as a Teratogenic Effect · Animal reproduction studies have not shown arthropathy or other musculoskeletal problems in offspring exposed to ciprofloxacin in utero 2, · While no clinical studies have been conducted in pregnant women, controlled prospective observational data suggest that in utero exposure to fluoroquinolones is not associated with clinically significant major musculoskeletal dysfunctions 9, · Seven women exposed to ciprofloxacin during second or third trimester delivered healthy normal babies. Motor, adaptive, social, and language milestones in each child were consistent with age, and no evidence of cartilage damage was found on regular clinical assessments up to five years of age 10,
Other Teratogenic Effects and Outcomes · Animal reproduction studies in mice, rats, and rabbits have revealed no evidence of teratogenicity in offspring exposed to ciprofloxacin in utero 2, Studies in pregnant monkeys did not produce detectable adverse effects on embryonic or fetal development 11, · Controlled prospective observational data on 200 fluoroquinolone-exposed human pregnancies (52.5% exposed to ciprofloxacin and 68% treated during the first trimester) showed the rate of major malformations among live-born children exposed during the first trimester was in the expected normal range of 1 – 5% as was the rate in controls. There were no differences in the rates of prematurity, spontaneous abortions, or birth weight 9, · Non-controlled prospective observational data on 70 ciprofloxacin-exposed human pregnancies (60% exposed during the first trimester) showed the rate of congenital malformations in live-born children exposed during the first trimester was 4.7%. The frequencies of spontaneous abortion/fetal death, post-natal disorders, prematurity and intra-uterine growth retardation did not exceed background rates 12, · In a company-sponsored prospective registry of 116 human pregnancies, 54% were exposed during the 1st trimester and resulted in live births. Of these, six were malformed. There was no pattern of anomalies seen among the reported spectrum of minor and major malformations 12,
Other Teratogenic Effects and Outcomes (cont’d) · An observational cohort study looking at human experience with five different antibiotics reported a total of 40 pregnancies with ciprofloxacin. Five of the nine women who received ciprofloxacin during the first trimester experienced normal births with no reported congenital abnormalities. The other four first trimester exposures were an ectopic pregnancy, a spontaneous abortion and two terminations 13, · One publication described six pregnant women exposed to longer durations of ciprofloxacin therapy (3 weeks to 3 months) who delivered normal babies 14, There has also been a case report of a pregnant woman exposed to three weeks of ciprofloxacin therapy during early third trimester who delivered a normal baby 15,
Duration of Exposure · The vast majority of reported experience with ciprofloxacin during human pregnancy (as described above) is short-term, 1st trimester exposure.
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Prepared by the Pregnancy Team, Food and Drug Administration 10/30/01
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Is doxycycline safe in pregnancy?

Doxycycline and breastfeeding – If your doctor or health visitor says your baby is healthy, you can take doxycycline for a short time (less than 3 weeks) while breastfeeding. Doxycycline passes into breast milk in fairly small amounts. However, the calcium in your milk sticks to the doxycycline so the baby cannot absorb very much.

When used for a short time, doxycycline is unlikely to cause side effects in your baby. When used for longer, there is a small chance that it can affect teeth and bone development. However, this has only happened when babies have been given doxycycline directly. It has not happened when babies have doxycycline through breast milk.

If you need to take doxycycline for longer than a few weeks, talk to your doctor or pharmacist. If your baby is not feeding as well as usual, has a rash, has stomach upset, or has oral thrush (a fungal infection in their mouth), or if you have any other concerns about your baby, talk to your doctor, pharmacist, health visitor or midwife.
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Does Augmentin safe in pregnancy?

Augmentin treatment during pregnancy and the prevalence of congenital abnormalities: a population-based case-control teratologic study – PubMed Objective: To study the human teratogenic potential of augmentin (amoxicillin+clavulanic acid) treatment during pregnancy.

  • Materials and methods: Pair analysis of cases with different congenital abnormalities and their matched controls in the population-based dataset of the Hungarian Case-Control Surveillance of Congenital Abnormalities, between 1991 and 1996.
  • Results: The case group included 6935 pregnant women who had offspring with congenital abnormalities, while the control group consisted of 10,238 pregnant women who had babies without any defects.

The number (and rate) of pregnant women with augmentin treatment was 52 (0.75%) and 56 (0.55%) in the case and control groups, respectively (crude odds ratio (OR) with 95% confidence interval (CI) was 1.4, 0.9-2.0). The comparison of augmentin treatments during the second-third months of pregnancy (i.e.

  1. In the critical period for most major congenital abnormalities) in case-control pairs did not show a higher use of augmentin in any congenital abnormality group.
  2. Conclusion: Augmentin treatment of pregnant women in usual therapeutic doses is unlikely to increase the risk of congenital abnormalities in newborn infants.

However, the number of cases and controls was limited, therefore, further multicenter-multinational studies are needed for the final risk assessment. : Augmentin treatment during pregnancy and the prevalence of congenital abnormalities: a population-based case-control teratologic study – PubMed
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Is metronidazole safe in pregnancy?

Pregnancy, breastfeeding and fertility while taking or using metronidazole You can use metronidazole while you’re pregnant.
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Which antibiotics are high risk?

Tracking hospital high-risk antibiotic use –

  • To get a better sense of how these antibiotics are impacting HA CDI rates, a team of researchers from the CDC; Becton, Dickinson and Company; and Nabriva Therapeutics looked at microbiologic and pharmacy data from 171 US community and teaching hospitals from June 2016 through July 2017, focusing on the combined use of the four high-risk antibiotics, with additional evaluation of the four classes individually.
  • Hospital-level use was measured as days of therapy (DOT) per 1,000 days present (DP).
  • Multivariable analysis estimated the relative risk (RR) of these antibiotics on HA CDI while controlling for other risk factors, such as community CDI pressure, length of hospital stay, proportion of elderly patients, and hospital characteristics.

The median use of the high-risk antibiotics across the 171 hospitals was 241.2 DOT per 1,000 DP. The most frequently used high-risk antibiotics were cephalosporins (47.9%), followed by fluoroquinolones (31.6%), carbapenems (13.0%), and lincosamides (7.6%). The median HA CDI rate across the hospitals was 33 per 10,000 admissions. The overall correlation between high-risk antibiotic use and HA CDI was 0.22 ( P =,003), with a higher correlation observed in teaching hospitals (0.38; P =,002) than in non-teaching hospitals (0.19; P =,055). When each class of high-risk antibiotics was evaluated individually, only cephalosporins were significantly correlated with HA CDI (0.23; P <,01). When other risk factors were accounted for, combined high-risk antibiotic use was independently associated with a significant risk for HA CDI, with an RR of 1.12 (95% confidence interval, 1.04 to 1.21, P =,002) for every 100-day increase of DOT per DP. Other factors independently associated with HA CDI rates included larger proportions of patients over 65 years of age, higher rates of community-associated CDI, longer hospital stays, and hospital teaching status. View complete answer

What are the 3 most common antibiotics?

The main types of antibiotics include: Penicillins – for example, phenoxymethylpenicillin, flucloxacillin and amoxicillin. Cephalosporins – for example, cefaclor, cefadroxil and cefalexin. Tetracyclines – for example, tetracycline, doxycycline and lymecycline.
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What is a natural antibiotic?

– Honey is one the oldest known antibiotics, tracing back to ancient times. Egyptians frequently used honey as a natural antibiotic and skin protectant. Honey contains hydrogen peroxide, which may account for some of its antibacterial properties. It also has a high sugar content, which can help stop the growth of certain bacteria.

  • Additionally, honey has a low pH level.
  • This works to pull moisture away from bacteria, causing the bacteria to get dehydrated and die off.
  • To use honey as an antibiotic, apply it directly to the wound or infected area.
  • The honey can help kill off the bacteria and aid in the healing process.
  • If possible, opt for raw Manuka honey,

This form of honey offers the most health benefits. You can purchase raw Manuka honey here, You can also ingest honey to aid in the treatment of internal infections. Simply swallow a whole tablespoon or stir it into a warm cup of herbal tea for a soothing treat.
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Which antibiotics cause birth defects?

Common antibiotics tied to miscarriages may also lead to birth defects By

  • (Reuters Health) – Pregnant women have another reason to avoid taking a class of antibiotics that includes erythromycin, clarithromycin and azithromycin: it may increase their baby’s risk of birth defects, a UK study suggests.
  • Compared to women prescribed penicillin during their first trimester, mothers given antibiotics in the macrolide class – which has already been tied to miscarriages – were 55% more likely to have a baby with major birth defects, the study found.
  • “Macrolides are frequently prescribed in pregnancy, and our findings suggest it would be better to avoid macrolides during pregnancy if alternative antibiotics can be used,” said study leader Heng Fan of University College London.
  • Many pregnant women who are allergic to penicillin are prescribed macrolides for bacterial infections, researchers note in The BMJ.
  • Fan’s team examined data on 104,605 children born from 1990 to 2016 whose mothers were prescribed penicillin or macrolides during pregnancy.

Overall, 186 children born to mothers prescribed macrolides at any point in pregnancy had major birth defects, including malformations of the brain and nervous system, heart and lungs, digestive tract, genitals or urinary tract. That translates into a birth defect rate of 28 out of every 1,000 babies.

  1. Macrolides taken during the first trimester were tied to a higher risk of cardiovascular malformations, with a birth defect rate of 11 out of 1,000 babies, compared with 7 in 1,000 babies for penicillin.
  2. Use of erythromycin during the first trimester was linked to a 27 per 1,000 rate of major malformations, versus 18 per 1,000 with penicillin.
  3. Macrolide use during any trimester was also linked to a genital malformations rate of 5 per 1,000 versus 3 per 1,000 with penicillin.
  4. Although the risk of major birth defects is higher with macrolides, the risk is still quite low and should be balanced against the even more serious problems that can develop for babies whose mothers have untreated bacterial infections during pregnancy, Fan said by email.
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Uterine infections – one use for antibiotics during pregnancy – can damage the placenta, contribute to premature labor and also lead to birth defects, for example. These infections can also make labor more difficult and dangerous for mothers and babies.

  • Along with to birth defects, researchers also looked for connections between antibiotics and cerebral palsy, epilepsy, attention deficit hyperactivity disorder (ADHD) and autism but found no links.
  • The study wasn’t designed to prove whether or how certain antibiotics might directly cause birth defects.
  • Still, it adds to evidence suggesting that macrolides should be avoided as much as possible during pregnancy, said Anick Berard of CHU Sainte-Justine and the University of Montreal.

“Given that infections need to be treated during pregnancy, I suggest less-problematic antibiotics use like penicillin or amoxicillin,” Berard, who wasn’t involved in the study, said by email. “These molecules are safe.” This may be easier said than done if more bacteria develop that are resistant to treatment with penicillin, Berard noted.
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Do antibiotics cross the placenta?

Abstract – Background: The purpose of antibiotic treatment in pregnant women is to treat the mother and/or the fetus since it is known that antibiotics administered to the mother cross the placenta and reach the fetus. A comparison of the drug concentration in maternal and fetal plasma gives an indication of the exposure of the fetus to the maternally administered antibiotics.

Aim: The aim of this study was to review the literature pertaining to the placental transfer of antibiotics in man and to classify the antibiotics according to the type of transfer involved. A table has been developed for use by physicians that lists the name of the antibiotic, the drug concentration in the cord and maternal plasma at delivery and the type of transfer involved.

Methods: An initial medline search was performed with the key words “placental transfer of antibiotics” with the limit of “human”. A second medline search was performed with the key words “placental transfer of.” followed by the class names of the antibiotic such as penicillins, cephalosporins, aminoglycosides, tetracyclines and macrolides.

The bibliographic search on the placental transfer of antibiotics covered the period up to July 2005. Results: 3 types of placental transfers were identified. A few antibiotics cross the placenta rapidly and equilibrate in the maternal and cord plasma; this type of transfer is termed “complete” and include the antibiotics ampicillin, methicillin, cefmenoxime and cefotiam.

Antibiotics which show incomplete transfer to the placenta where concentrations are lower in the cord than maternal plasma are said to have “incomplete” transfer and these include azlocillin, dicloxacillin, piperacillin, sulbenicillin, cefoxitin, amikacin, gentamicin, kanamycin, streptomycin, fosfomycin, thiamphenicol, griseofulvin, vancomycin and colistimethate.
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Why ciprofloxacin is not used in pregnancy?

– Ciprofloxacin ( Cipro ) and levofloxacin are also types of antibiotics. These drugs could cause problems with the baby’s muscle and skeletal growth as well as joint pain and potential nerve damage in the mother. Ciprofloxacin and levofloxacin are both fluoroquinolone antibiotics.
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Is ciprofloxacin safe in pregnancy?

Ciprofloxacin is approved for prophylaxis following inhalational anthrax exposure 1, According to the Centers for Disease Control and Prevention (CDC), ciprofloxacin (500 mg, orally, two times a day for 60 days) is the antibiotic of choice for initial prophylactic therapy among asymptomatic pregnant women exposed to Bacillus anthracis,

In instances where the specific B. anthracis strain has been shown to be penicillin-sensitive, prophylactic therapy with amoxicillin (500 mg, orally, three times a day for 60 days) may be considered 2, CDC guidelines for treatment of anthrax infection in pregnant women recommend either ciprofloxacin or doxycycline with one or two other antibiotics added for inhalational anthrax or systemic involvement 3,

While there are no controlled studies of ciprofloxacin use in pregnant women to show safety, an expert review of published data on experiences with ciprofloxacin use during pregnancy by TERIS – the Teratogen Information System – concluded that therapeutic doses during pregnancy are unlikely to pose a substantial teratogenic risk (quantity and quality of data = fair), but the data are insufficient to state that there is no risk 4,

However, there are no human data available to assess the effects of long-term therapy in pregnant women such as that proposed for treatment of anthrax exposure. Ciprofloxacin is excreted into breast milk but is considered as “usually compatible with breastfeeding” by the American Academy of Pediatrics.5 Background: The association between fluoroquinolones and arthropathy, although observed in immature animals and rarely reported in humans, has resulted in the restricted use of fluoroquinolones during pregnancy.

Young dogs given ciprofloxacin developed arthropathy with permanent cartilage erosion in weight-bearing joints. Similar arthropathies have been reported in neonatal mice 6, Transient arthropathy has been reported in a small number of patients with cystic fibrosis 7, 8

Arthropathy as a Teratogenic Effect · Animal reproduction studies have not shown arthropathy or other musculoskeletal problems in offspring exposed to ciprofloxacin in utero 2, · While no clinical studies have been conducted in pregnant women, controlled prospective observational data suggest that in utero exposure to fluoroquinolones is not associated with clinically significant major musculoskeletal dysfunctions 9, · Seven women exposed to ciprofloxacin during second or third trimester delivered healthy normal babies. Motor, adaptive, social, and language milestones in each child were consistent with age, and no evidence of cartilage damage was found on regular clinical assessments up to five years of age 10,
Other Teratogenic Effects and Outcomes · Animal reproduction studies in mice, rats, and rabbits have revealed no evidence of teratogenicity in offspring exposed to ciprofloxacin in utero 2, Studies in pregnant monkeys did not produce detectable adverse effects on embryonic or fetal development 11, · Controlled prospective observational data on 200 fluoroquinolone-exposed human pregnancies (52.5% exposed to ciprofloxacin and 68% treated during the first trimester) showed the rate of major malformations among live-born children exposed during the first trimester was in the expected normal range of 1 – 5% as was the rate in controls. There were no differences in the rates of prematurity, spontaneous abortions, or birth weight 9, · Non-controlled prospective observational data on 70 ciprofloxacin-exposed human pregnancies (60% exposed during the first trimester) showed the rate of congenital malformations in live-born children exposed during the first trimester was 4.7%. The frequencies of spontaneous abortion/fetal death, post-natal disorders, prematurity and intra-uterine growth retardation did not exceed background rates 12, · In a company-sponsored prospective registry of 116 human pregnancies, 54% were exposed during the 1st trimester and resulted in live births. Of these, six were malformed. There was no pattern of anomalies seen among the reported spectrum of minor and major malformations 12,
Other Teratogenic Effects and Outcomes (cont’d) · An observational cohort study looking at human experience with five different antibiotics reported a total of 40 pregnancies with ciprofloxacin. Five of the nine women who received ciprofloxacin during the first trimester experienced normal births with no reported congenital abnormalities. The other four first trimester exposures were an ectopic pregnancy, a spontaneous abortion and two terminations 13, · One publication described six pregnant women exposed to longer durations of ciprofloxacin therapy (3 weeks to 3 months) who delivered normal babies 14, There has also been a case report of a pregnant woman exposed to three weeks of ciprofloxacin therapy during early third trimester who delivered a normal baby 15,
Duration of Exposure · The vast majority of reported experience with ciprofloxacin during human pregnancy (as described above) is short-term, 1st trimester exposure.

Prepared by the Pregnancy Team, Food and Drug Administration 10/30/01
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Is cefixime safe during pregnancy?

Cefixime Pregnancy Warnings – Animal studies have failed to reveal evidence of fetal harm or impaired fertility at doses up to 400 times the recommended human dose; however, there was increased incidence of abortion at levels reaching maternal toxicity.

There are no controlled data in human pregnancy. US FDA pregnancy category B: Animal reproduction studies have failed to demonstrate a risk to the fetus and there are no adequate and well-controlled studies in pregnant women. Use is recommended only if clearly needed and the benefit outweighs the risk.

US FDA pregnancy category: B See references
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Is metronidazole safe in pregnancy?

Pregnancy, breastfeeding and fertility while taking or using metronidazole You can use metronidazole while you’re pregnant.
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