Use of Antibiotic in Pregnancy and Lactation

At any time many women are pregnant or lactating worldwide. The medication use by these women is accompanied by significant risks. In addition to normal physiologic changes that alter the pharmacokinetics of drugs, there is concern for the possible teratogenicity and toxic effects of the drugs on the developing fetus and newborn. This article reviews the risks and pharmacokinetic considerations for 10 broad-spectrum antibiotics that can be used to treat various infections during pregnancy and lactation. Information from the Pub Med was reviewed concerning the use of 10 antibiotics (amoxicillin, penicillin G and V, doxycycline, chloramphenicol, ciprofloxacin, rifampin, clindamycin, gentamicin, vancomycin) in pregnant and lactating women. The PubMed search engine was used with the search terms [antibiotic name] and teratogen or tratogenic “[antibiotic name] and pregnancy,” “[antibiotic name] and lactation,” and “[antibiotic name] and breast-feeding” from 1966 to November 2007. Standard reference tracing was done as well. The Scientific Information Database was searched with the similar keywords for Persian articles. One hundred and one references had sufficient information regarding the number of subjects, and the methods. So their findings were included in the study. The teratogenic potential of the drugs in humans ranged from “none” for penicillin G and penicillin V to “unlikely” for amoxicillin, chloramphenicol, ciprofloxacin, doxycycline, and rifampin and to “undetermined” for clindamycin, gentamicin, and vancomycin. Significant pharmacokinetic changes occur during pregnancy for penicillins, fluoroquinolones, and gentamicin, which indicate that dosage of these drugs should be adjusted in the pregnancy period. All of these antibiotics but chloramphenicol can be prescribed during breast-feeding period. Having considered the possible teratogenicity and side effects of these drugs, penicillin and amoxicillin can be prescribed safely but tetracycline should be avoided during pregnancy and lactation.