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CPD: Antibiotics in pregnancy

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CPD: Antibiotics in pregnancy

Antibiotics are commonly prescribed to treat (or in some cases prevent) a vast array of infections, but when the patient is pregnant, even more careful consideration must be put into choosing a suitable antibiotic that will be effective at combating infection whilst minimising risks to both the patient and their baby.

From a pharmacists point of view it is vital that we can assess the clinical appropriateness of antibiotic prescribing in pregnancy and can confidently intervene if issues are identified. According to the results of many studies, the following antibiotics may be considered safe during pregnancy:

  • Penicillins
  • Erythromycin
  • Clindamycin
  • Nitrofurantoin

In March last year, new research suggested a possible link between macrolide use in pregnancy and increased risk of cerebral palsy and/or other epilepsy. Whilst the initial reaction may be one of alarm, the authors noted that the results do not indicate a clear causal relationship due to the presence of other confounding factors.

For example, the type of infection was not considered. It is possible that macrolides were given to pregnant women suffering from infections that are inherently more dangerous to the growing foetus. Another possibility is that the macrolides were more poorly tolerated due to adverse side effects which may subsequently have had an effect on patient compliance which, in turn, may have allowed infections to remain untreated.

More research needs to be done to identify if there is a direct causal relationship between macrolide use in pregnancy and risk of cerebral palsy and/or other epilepsy and, until that point, macrolides should be considered a safe antibiotic agent. Unfortunately there is no such thing as a completely risk-free medicine but the implications of leaving infections untreated in pregnant patients can be profoundly severe.

Prescribing practice should be based on evaluating the benefits and risks to the patient and their unborn baby using current best evidence. And pharmacists must be satisfied that their patients’ antibiotic treatment is appropriate and that they are comprehensively counselled on how to safely and effectively take their medicines to maximise health outcomes

 

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