This list serves as a guide and is only a summary of the antimicrobials listed on the hospital formulary in this special population. The benefit of treatment and the safety profile of the drug to mother and fetus/baby should be considered and discussed individually with each patient. For more information, please contact a clinical pharmacist or Motherisk at (416)813-6780.
As of June, 2015, the original FDA Pregnancy Category system have been replaced by narrative sections in the product labeling.
Antimicrobial Agents
| Antimicrobial Class / Agent | Pregnancy | Breastfeeding |
|---|---|---|
| Aminoglycosides – Gentamicin – Tobramycin – Amikacin | Human data suggest low risk Monitor drug concentrations | Compatible |
| Carbapenems – Ertapenem – Meropenem | Limited human data suggest low risk | Probably compatible |
| Cephalosporins – Cefazolin – Cephalexin – Cefuroxime – Ceftriaxone – Ceftazidime | Compatible | Compatible |
| Clindamycin | Compatible | Compatible |
| Daptomycin | Limited human data; animal studies suggest low risk | Limited human data; probably compatible |
| Fluoroquinolones – Ciprofloxacin – Levofloxacin – Moxifloxacin | Human data suggest low risk Data on ciprofloxacin did not suggest an increased risk of major malformations Limited human data for levofloxacin or moxifloxacin | Limited human data, but short-term use is acceptable during breastfeeding No human data in moxifloxacin |
| Fosfomycin | Compatible | Limited human data, but probably compatible |
| Linezolid | No human data; use safer alternatives if possible | No human data; use safer alternatives if possible |
| Macrolides – Erythromycin – Clarithromycin – Azithromycin | Erythromycin / Azithromycin: Compatible Avoid Erythromycin Estolate (increased incidence of maternal hepatotoxicity) Clarithromycin: limited human data | Erythromycin: Compatible Azithromycin / Clarithromycin: Limited human data, but probably compatible |
| Metronidazole | Human data suggest low risk | Limited human data If use as single-dose therapy (2g orally), delay breastfeeding for 12 to 24 hours |
| Nitrofurantoin | Avoid after 37 weeks (risk of hemolytic anemia in newborns) | Limited human data, but probably compatible Potential risk of hemolytic anemia in newborn |
| Penicillins – Penicillin G / VK – Ampicillin – Amoxicillin ± Clavulanic acid – Cloxacillin – Piperacillin Tazobactam | Compatible | Considered safe |
| Rifampin | Compatible Prophylactic vitamin K1 has been recommended to prevent hemorrhagic disease in the newborn | Compatible |
| Tetracyclines – Doxycycline – Tetracycline – Minocycline | Avoid in 2nd/3rd Trimesters | Compatible Black discolouration of breast milk has been reported with minocycline (iron chelate of drug) |
| Trimethoprim [TMP] + sulfamethoxazole [SMX] ( Septra ® ) | Avoid in 1st trimester and after 32 weeks’ gestation If use during 1st trimester is necessary, can give high dose folic acid (4-5mg/day) to minimize neural tube defects | Avoid if infant has G6PD deficiency, premature infants or neonates with hyperbilirubinemia TMP alone is compatible |
| Vancomycin | Compatible | Limited human data, but probably compatible |
Anti-Fungal Agents
| Anti-Fungal Class / Agent | Pregnancy | Breastfeeding |
|---|---|---|
| Amphotericin B (including liposomal amphotericin) | Compatible | No human data |
| Anidulafungin | No controlled studies in pregnancy | No human data |
| Caspofungin | No human data Embryotoxic in animal studies; should be avoided in 1st trimester whenever possible | No human data-Probably comptable |
| Fluconazole | May be teratogenic with continuous daily doses >400mg/day in 1st trimester Decreased risk in lower doses | Compatible |
| Voriconazole | No human data Animal studies suggest drug is teratogenic and embryotoxic | No human data (potential toxicity) |
Antiviral Agents
| Antriviral Class / Agent | Pregnancy | Breastfeeding |
|---|---|---|
| Acyclovir / valacyclovir | Compatible | Compatible |
| Ganciclovir / valganciclovir | Limited human data and only should be used when benefit outweighs unknown risk to the fetus | No human data |
| Oseltamivir | Compatible based on limited human data | Compatible |
References
- Briggs GG et al. Drugs in Pregnancy and Lactation –9thedition. Philadelphia: Lippincott Williams & Wilkins; 2011.
- Various drug monographs. In: DRUGDEX System [database on the Internet]. Colorado:Truven Health Analytics; 2015[cited February 2015]. Available from: www.micromedexsolutions.com. Subscription required to view.
- Motherisk. Pregnancy and breastfeeding: the safety of anti-infective agents. In: Cornish B, Walker S AN. Antimicrobial Handbook 2013. Toronto: Sunnybrook Health Sciences Centre; 2013. Pages 73-90.
- Einarson A, Ho E, Koren G. Can we use metronidazole in pregnancy? Putting an end to the controversy [Internet]. 2000 [cited February 2015]. Available from: http://www.motherisk.org/prof/updatesDetail.jsp?content_id=328
- Zao J, Koren G, Bozzo P. Using nitrofurantoin while breastfeeding a newborn [Internet]. 2014[cited February 2015]. Available from: http://www.motherisk.org/prof/updatesDetail.jsp?content_id=1079
- Lee M, Bozzo P, Einarson A, Koren G. Urinary tract infections in pregnancy [Internet]. 2008 [cited February 2015]. Available from: http://www.motherisk.org/prof/updatesDetail.jsp?content_id=882
- Product monograph –Invanz. Quebec: Merck Canada Inc; 2014.
- Product monograph –Cubicin. Massachusetts: Cubist Pharmaceuticals Inc; 2014.
- Bookstaver PB, Bland CM, Stover KR et al. A review of antibiotic use in pregnancy. Pharmacother 2015;35(11):1052-62.