Antibiotic chemotherapy during pregnancy and lactation period: aspects for consideration

Infections during gestation, delivery and the postnatal period can jeopardise not only the mother, but also the child. Along with chromosomal abnormalities and immunological diseases, infection in early pregnancy represents the most important reason for abortion. During the second and third trimester, infections are the principal cause for preterm labour, premature membrane rupture, premature delivery and the resultant complications in the newborn child. Many pregnant women are very cautious about taking antibiotics due to primarily potentially detrimental effects on the unborn child. However, there are no contraindications for antibiotic treatment during pregnancy in the event of a serious infectious disease of the mother.

In this review the indications and contraindications of the administration of antibiotics during pregnancy are being reviewed.

Penicillins are a first-line antibiotic treatment during pregnancy, with the exception of cases in which there is a maternal allergy to penicillin. Cephalosporins are another first-line antibiotic used during pregnancy. In principle, more commonly used cephalosporins should be given priority. Owing to associated nephrotoxicity and ototoxicity, aminoglycosides should not be prescribed at any time during pregnancy. Systematic use of aminoglycosides should be considered solely in the event of life-threatening infections with gram-negative pathogens and/or treatment failure of recommended antibiotics during pregnancy. The use of metronidazole is also permitted during pregnancy, provided the indications for its use have been strictly verified. Lincosamides should be used only if penicillins, cephalosporins and erythromycin have failed to eradicate infection. Sulfonamides, trimethoprim and cotrimoxazole are second-line agents for the use during pregnancy. Tetracyclines should not be administered to pregnant women after the fifth week of pregnancy, and are deemed contraindicated. As a precautionary measure, gyrase inhibitors are also contraindicated for pregnant women, children and young adolescents.

On the basis of our current state of knowledge, the vast majority of antibiotics do not cause serious harm to the unborn child if used properly and at the appropriate doses during pregnancy. The treatment with an antibiotic that is contraindicated does not justify termination of pregnancy. However, ultimately no medicine, including antibiotics, can be described as absolutely safe.