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[Antibiotics in pregnancy: importance of rational utilization]
J P Langhendries1, A Denoel, D Rousseaux
1Centre Néonatal, CHVE, Clinique St-Vincent, Rocourt.
Insights
Antibiotic use during pregnancy can prolong gestation and reduce infant infections. However, it may also increase resistant sepsis and atopic disorders, necessitating careful antibiotic selection and administration.
Area of Science:
- Obstetrics and Gynecology
- Neonatology
- Microbiology
Context:
- Antenatal antibiotic treatment prolongs pregnancy in preterm premature rupture of membranes and reduces neonatal infections.
- Prophylactic intrapartum antibiotics decrease early-onset group B Streptococcus sepsis.
- Perinatal antibiotic exposure is linked to increased resistant neonatal sepsis and atopic disorders due to gut microbiome disruption.
Purpose:
- To highlight the critical aspects of antibiotic use in the perinatal period.
- To emphasize the need for rational antibiotic selection and administration.
- To underscore the importance of considering pharmacodynamics and pharmacokinetics in neonates.
Summary:
- Antibiotics in pregnancy offer benefits like prolonged gestation and reduced neonatal infections but pose risks such as increased resistant sepsis and atopic conditions.
- Guidelines for perinatal antibiotic use are a public health priority, requiring careful consideration of local epidemiology, infection timing, and clinical evaluation.
- Understanding drug pharmacodynamics/pharmacokinetics is crucial for optimizing efficacy, minimizing toxicity, and combating antimicrobial resistance, especially in neonates.
Impact:
- Informing clinical practice for safer and more effective perinatal antibiotic use.
- Guiding the development of evidence-based guidelines for antibiotic stewardship in obstetrics and neonatology.
- Reducing the incidence of antibiotic-resistant infections and atopic disorders in infants.
Abstract:
It is now clear that antibiotic treatment in the antenatal period significantly does prolong pregnancy during conservative management of preterm premature rupture of membranes and reduces neonatal infectious diseases as well as neonatal-related morbidities. In the same way, prophylactic intrapartum antibiotherapy reduces the incidence of early-onset group B Streptococcus-induced sepsis. Nevertheless, on the other hand, antibiotics in the perinatal period are associated with an increase of neonatal sepsis by organisms resistant to maternally administered antibiotics. In addition, antibiotic treatment in this period of time is emerging as one of the possible sources of the dramatic increase in atopic disorders in infants and children owing to the interference with the normal process of intestinal microbial colonization. So, guidelines for using antibiotics in the perinatal period can be said as one of the major priority in public health. Antibiotics have therefore to be rightly choosen and must be used in a rational manner. Local microbial epidemiology, period of infection onset, clinical evaluation, all together allow the physician to use antibiotics, always in association, according to the "well-thought-out wager". In addition, the pharmacodynamic/pharmacokinetic relationship of each drug has to be known, in order to increase efficacy, decrease toxicity and reduce microbial resistance. It is especially mandatory in neonatology where the differences in drug distribution and drug elimination are of great concern, as compared to children and adults. The aim of this paper is to point out such very important aspects using antibiotics in the perinatal period.