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Antibiotics in Pregnancy

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

I. See Also

  1. Vaccination in Pregnancy
  2. Medications in Pregnancy
  3. Acute Cystitis in Pregnancy
  4. Pyelonephritis in Pregnancy
  5. HIV in Pregnancy

II. 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)

III. 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 27:1151-60 [PubMed]
    8. Itraconazole (Sporanox)
    9. Ketoconazole (Nizoral)
      1. Teratogenic and Embryotoxic in animals
      2. Associated with hepatotoxicity
    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

IV. 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 172:525-9 [PubMed]
  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 [PubMed]
    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

V. 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. MeaslesVaccine
    2. Mumps Vaccine
    3. RubellaVaccine
    4. Small PoxVaccine
    5. TC-83 Venezuelan Equine EncephalitisVaccine
    6. Varicella Vaccine
      1. Risk if vaccinated within 4 weeks of conception
      2. Theoretic risk only; not an indication for EAB

VI. References

  1. Briggs (1998) Drugs in Pregnancy and Lactation, 5th ed
  2. Black (2003) Am Fam Physician 67(12):2517-24 [PubMed]
  3. Larimore (2000) Prim Care 27(1):35-53 [PubMed]

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