Antibiotics in Pregnancy

Class B: No risk in controlled animal studies A- Antifungal Topical Agents Nystatin (Mycostatin) B- Antiparasitic agents Metronidazole or Flagyl (after first Trimester) Avoid single dose therapy Praziquantel - not in Briggs Permethrin (topical) - not in Briggs (1998) C- Anti-Tuberculosis agents Ethambutol Didanosine - not in Briggs (1998) D- Antiviral agents Nelfinavir - not in Briggs (1998) Ritonavir Saquinavir Famciclovir Valacyclovir E- Antibiotics All Cephalosporin Antibiotics (except Moxalactam) All Erythromycin except Erythromycin Estolate

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Azithromycin (Zithromax) All Penicillin Antibiotics Clindamycin Macrodantin (before third trimester) Sulfa antibiotics (before third trimester) ------------------------------Class C: Small risk in controlled animal studies A- Antifungal agents CDC recommends only Topical Antifungal in pregnancy Avoid Antifungals in first trimester if possible Terbinafine (Lamisil) - not in Briggs (1998) Clotrimazole (Mycelex, Lotrimin) Butoconazole (Femstat) Miconazole (Monistat) Amphotericin B Fluconazole (Diflucan) No fetal adverse effects seen in one study King (1998) Clin Infect Dis 27:1151-60 Itraconazole (Sporanox) Ketoconazole (Nizoral) Teratogenic and Embryotoxic in animals Griseofulvin Teratogenic and Embryotoxic in animals B- Antimalarial agents Mefloquine (Lariam) Chloroquine Primaquine C- Antiparasitic agents Albendazole - not in Briggs (1998) Ivermectin - not in Briggs (1998) Mebendazole Pentamidine Thiabendazole Pyrantel D- Anti-Tuberculosis agents Dapsone Isoniazid (INH)

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Pyrazinamide Rifampin E- Antiviral agents Lamivudine Stavudine Zalcitabine Zidovudine Delavirdine - not in Briggs (1998) Nevirapine Indinavir Cidofovir Foscarnet Ganciclovir Acyclovir Amantadine Rimantadine Interferon alpha F- Antibiotics Imipenem-Cilastin All Fluoroquinolone antibiotics Clarithromycin (Biaxin) Pediazole - not in Briggs (1998) Sulfisoxazole - not in Briggs (1998) Trimethoprim Vancomycin Chloramphenicol Gentamicin ------------------------------Class D: Strong evidence of risk to the human fetus A- Antiparasitic agents Metronidazole or Flagyl (First Trimester) 1- New evidence suggests first trimester safety 2- Burtin (1995) Am J Obstet Gynecol 172:525-9 B- Antibiotics - Amikacin (Class D per manufacturer) - Kanamycin - Streptomycin

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- Tobramycin (Class D per manufacturer) - Sulfa (Third Trimester) - All Tetracycline antibiotics (Doxycycline, Tetracycline and Minocycline) - Erythromycin Estolate (llosone) - Due to hepatotoxicity in pregnant women - Macrobid and Nitrofurantoin (Third Trimester) 1- Do not use either of these past 38 weeks 2- Can cause Hemolytic Anemia in newborns 3- Related to immature liver and G6PD Deficiency C- Vaccines Yellow Fever Vaccine ------------------------------Class X: Very high risk to the human fetus A- Antimalarial agents - Quinine B- Antiviral agents - Ribavirin - Rebetron - not in Briggs (1998) C- Vaccines - MeaslesVaccine - Mumps Vaccine - RubellaVaccine - Small PoxVaccine - TC-83 Venezuelan Equine EncephalitisVaccine - Varicella Vaccine 1- Risk if vaccinated within 4 weeks of conception 2- Theoretic risk only; not an indication for EAB -------------------------------This Article has been Authored By :: World Of Dentistry :: TEAM For any questions and sugesstions please don't be hesitate to feedback us. Yours, :: World Of Dentistry :: TEAM

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