PREGNANCY
Antimicrobial agents administered to pregnant women may be harmful to the developing foetus.
The major period of danger for teratogenic effects is during the first trimester, although some drugs can interfere with the functional development of organ systems and the central nervous system in the second and third trimester, and have serious consequences.
All antimicrobial agents should be avoided in the first 12 weeks of pregnancy.
If antimicrobial agents are to be prescribed, the risk and benefits to the mother and/or foetus must be considered.
ANTIBIOTIC RISK CATEGORIES IN PREGNANCY
- Category A – Drugs which have been taken by a large number of pregnant women and women of childbearing age without any proven increase in the frequency of malformations or other direct or indirect harmful effects on the foetus.
- Category B – Drugs which have been taken by only a limited number of women of childbearing age without an increase in the frequency of malformations or other indirect or direct harmful effects on the human foetus. Studies in animals have not yet shown evidence of an increased occurrence of foetal damage.
- Category C – Animal reproductive studies have shown foetal adverse effects and/or malformations. There have been no controlled studies in humans. On a risk-benefit ratio it might be beneficial to use during pregnancy despite the risk.
- Category D – Drugs which may be expected to cause an increased incidence of human foetal malformations or irreversible damage. These drugs may also have adverse pharmacological effects.
- Category X – Drugs which have such a high risk of causing permanent damage to the foetus that they should not be used in pregnancy or when there is a possibility of pregnancy.
BREASTFEEDING
The benefits of breastfeeding are sufficiently important to recommend that breastfeeding should be continued, unless there is substantial evidence that the drug taken by the mother will be harmful to the infant and that no therapeutic equivalent can be given. Most drugs are excreted only to a minimal extent in breast milk, and in most cases the dose to which the infant is ultimately exposed is very low and is well below the therapeutic dose level for infants. For this reason, there are few drugs which are totally contraindicated while breastfeeding.
SAFETY TABLE: ANTIMICROBIALS
Below is a selection from the detailed table showing Pregnancy Category and Breastfeeding Safety:
✳ Full tables for over 150+ antimicrobials are available in the PDF and can be formatted in tabular CMS entries if needed.
SAFETY TABLE: ANTIRETROVIRALS
AntiretroviralPregnancy CategoryBreastfeedingAbacavirCBenefits outweigh potential riskDolutegravirBBenefits outweigh potential riskEfavirenzDBenefits outweigh potential riskEmtricitabineBBenefits outweigh potential riskLopinavir/ritonavirCBenefits outweigh potential riskNevirapineBBenefits outweigh potential riskTenofovirBBenefits outweigh potential riskZidovudineCBenefits outweigh potential risk
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