WHICH ORAL ANTIBIOTICS ARE SAFE DURING PREGNANCY AND BREASTFEEDING?

Many are okay...and LESS risky than an untreated infection. But some have special precautions...and several should be avoided.
Penicillins and cephalosporins are usually safe.
Consider using a higher or more frequent dose during the 2nd and 3rd trimesters...to compensate for the increased volume of distribution and clearance.
Erythromycin and azithromycin are also generally safe in pregnancy. Don't use clarithromycin...due to concerns about birth defects in animal studies.
Nitrofurantoin is usually okay during pregnancy and breastfeeding. Don't use it close to delivery due to a small chance of hemolytic anemia in the newborn.
TMP/SMX should usually be avoided. Trimethoprim may cause birth defects during the 1st trimester...and sulfonamides may cause high bilirubin and jaundice in the baby if given near term.

Metronidazole is sometimes avoided in the 1st trimester due to concerns about possible malformations. But it can be used during pregnancy if there are no good alternatives.
For a single dose while breastfeeding, suggest stopping breastfeeding for 12 to 24 hours to allow the drug to be eliminated.
Clindamycin is an alternative to metronidazole for anaerobic coverage and is considered safe in pregnancy and lactation.
Fluoroquinolones (ciprofloxacin, etc) are associated with cartilage damage in animals. Even though this isn't confirmed in humans, try to avoid fluoroquinolones during pregnancy.
Tetracyclines should be avoided in pregnancy...especially in the 2nd and 3rd trimesters. They're associated with adverse effects on fetal teeth and bones, other defects, and maternal liver toxicity.
Tell moms that tetracycline can be used during breastfeeding...it only shows up in very low concentrations in breast milk.

On-line resources:
Motherisk. http://www.motherisk.org/index.jsp. Offers consumers answers to questions about morning sickness and the risk or safety of medications, disease, chemical exposure, and more. Provides teratogen information for healthcare professionals and updates on Motherisk's continuing reproductive research.
Perinatology.com. http://www.perinatology.com/. Provides teratogen information for healthcare professionals and links to clinical guidelines and more.
Organization of Teratology Information Specialists (OTIS). http://www.otispregnancy.org/. Provides medical consultation on prenatal exposures for consumers and healthcare professionals.
OBfocus. http://www.obfocus.com/. Provides information for healthcare professionals and consumers on pregnancy related issues, including drug exposure. Provides a list of resources on high risk pregnancy



Please remember, as with all our articles we provide information, not medical advice.
For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.

* Tune in tomorrow for Women Still Drinking During Pregnancy

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