The Use of Antimicrobials in Pregnancy

Abstract

The use of antimicrobials in pregnancy is associated with a potential risk for deleterious effect on fetus and neonate. Pregnancy may be associated with changes in pharmacokinetics because of reduced renal blood flow and glomerular filtration, increased blood volume, changes in albumin concentrations. The above factors can lead to suboptimal dosing regimens. Antimicrobials may have the following effects: embryotoxic, teratogenic, fetotoxic. Initial safety information is obtained from analysis of chemical structure, in vitro and animal studies. The main data are collected in clinical and observational studies. The most widely used criteria for determination of possibility of drugs use in pregnancy are FDA recommendations. In Australia and Sweden more detailed classifications are in use. In general, the majority of antimicrobials are relatively safe for fetus. It could be explained by the absence of specific target in mammalian cells. In addition, antimicrobials are usually administered by relatively short courses compare to other drugs. At the same time the duration of exposure is one of the crucial factors in the development of teratogenic effect.