Antiinfective therapy for pregnant or lactating patients in the emergency department

Special considerations in pharmacotherapy for infectious diseases in pregnant and lactating women in the emergency department (ED) setting are reviewed.

With many women turning to the ED as a source of primary care, it is essential for pharmacists involved in providing ED services to guide the selection of appropriate antiinfective agents during pregnancy and lactation; this area of practice is complicated by the very limited body of published data on the safety and efficacy of maternal antimicrobial use and potential fetal or neonatal adverse effects. Infectious diseases commonly encountered in the ED include sexually transmitted diseases, bacterial vaginosis and other vaginal infections, respiratory and urinary tract infections, and pneumonia. Recommended first-line therapies for pregnant or lactating women may differ from those recommended for other patient populations. Although some widely used antiinfective classes and agents are generally considered safe for use in pregnant women, others (e.g., clarithromycin, fluoroquinolones) have been linked to birth defects and neonatal adverse effects. In addition to guiding ED practitioners in the appropriate use of antiinfective agents in pregnant women and nursing mothers, pharmacists can reinforce the importance of appropriate follow-up care (including specialist referral or culture testing in some cases) and ongoing preventive health measures such as vaccine administration.

The use of antiinfective agents in pregnant or lactating women requires consideration not only of the drugs' effectiveness but also their possible effects on the fetus or newborn and the nature of follow-up care. References are available to help clinicians make treatment decisions.