Antibiotics in Pregnancy
Several times per week I am approached by a patient regarding which antibiotics are safe for her to use in pregnancy. Usually this question comes from their dentist who wants to perform a dental procedure, and ants to use an antibiotic for prophylaxis. The concern is that some antibiotics are known teratogens. Teratogens cause malformations in the developing embryo or fetus. Teratogens can be antibiotics, viruses, and other substances. Examples of known teratogens include: ACE inhibitors,radiation, cytomegalovirus, rubella virus, alcohol, cocaine, lead etc.
Most of the information regarding safety of antibiotics in pregnancy are obtained from women who took the drug “by accident” or when they didn’t know they were pregnant, and then they were followed to see the outcome of the baby. These are called retrospective studies. Because of safety concerns about risks to the developing baby, pregnant women are excluded from most drug studies. The FDA has assigned a letter category to all drugs that is used to rate a drug’s safety in pregnancy. It is generally accepted that Category A, and B drugs are safe in pregnancy.
An excellent resource from the FDA is here: (http://www.fda.gov/ForConsumers/ByAudience/ForWomen/ucm118567.htm). Known drugs that are teratogens are given a Category X.Frequently encountered infections in pregnancy include, urinary tract infections, pyelonephritits (kidney infection), bladder infection, pneumonia, cold, bronchitis, sinusitis, among others. A few of the commonly used antibiotics include Amoxicillin, Ampicillin, Clindamycin, Erythromycin, Penicillin, Keflex,Augmentin. These are category B.
In May 2011, the American College of Obstetricians and Gynecologists issued a monograph stating that most antibiotics are safe during pregnancy(http://www.acog.org/About%20ACOG/News%20Room/News%20Release/2011/Most%20Antibiotics%20Are%20Safe%20During%20Pregnancy.aspx).
There are many conditions that require that a pregnancy category C drug be taken. This includes anti-seizure medications, and some mood stabilizer medications among other. If you are prescribed ANY antibiotics you should have a discussion with your practitioner to assess the benefit vs risk of taking these medications during pregnancy.
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