Vol.65 No.1 January 2017
Precautions in use of antimicrobial agents for pregnant/puerperal women
School of Nursing Division of Obstetrics and Gynecology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Hirokoji Agaru, Kawaramachi-dori, Kamigyo-ku, Kyoto, Japan
Abstract
Various infections can occur in pregnant women, including sexually transmitted infection and gonadal, urinary tract, and respiratory tract infections. Pregnant women are often reluctant to take drugs prescribed by physicians, and physicians issuing prescriptions also tend to refrain from medicating pregnant women whenever possible.
When drugs are prescribed, changes in pharmacokinetics during pregnancy (changes in renal function, hepatic function, distribution volume and protein binding) need to be taken into consideration. Most drugs administered to pregnant women can reach the fetus through the placenta, with only a few exceptions. This potential for drug passage through the placenta is an important factor in selecting drugs for pregnant women.
Risk categories have been established by the FDA (USA), while risk classification have also been established by the ADEC (Australia).
In Japan, antimicrobial drugs studied by the Mother-Child Chemotherapy Study Group. A study entitled "Influence of maternal use of antibiotics on fetuses and newborns," which was conducted in the latter half of 1955, was the starting point for this study. The study later expanded to include the selection of antibiotics that should be avoided during pregnancy. The Mother-Child Chemotherapy Study Group was founded within the framework of the activities of the Japanese Society of Chemotherapy and conducts studies on mother-to-fetus transfer of antibiotics, the significance of the amniotic fluid concentration, drug transfer into milk, and so on.
1) Antimicrobial drugs that are considered to be safe include: penicillins, cephems, macrolides, and clindamycin
2) Antimicrobial drugs that can be used with appropriate care include: aminoglycosides, metronidazole, sulfamethoxazole-trimethoprim, and glycopeptides
3) Antimicrobial drugs that are contraindicated: during pregnancy include tetracyclines and, new quinolones
Based on the presently accumulated knowledge, pregnant women requiring medication should receive appropriate advice to ensure that they understand the need and safety of antimicrobial chemotherapy as well as to foster an environment allowing pregnant women to participate in treatment.
Key word
antimicrobial chemotherapy, pregnancy, breastfeeding
Received
August 25, 2016
Accepted
September 20, 2016
Jpn. J. Chemother. 65 (1): 4-9, 2017
