Antepartum Use of Antibiotics

Hyun-Hwa Cha

doi:10.14734/kjp.2014.25.4.235

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Cha: Antepartum Use of Antibiotics

Original Article

Korean J Perinatol 2014;25(4):235-245.

Published online: 21 December 2014

DOI: https://doi.org/10.14734/kjp.2014.25.4.235

Antepartum Use of Antibiotics

Hyun-Hwa Cha, M.D.

Department of Obstetrics and Gynecology, Kyungpook National University Hospital Kyungpook National University School of Medicine, Daegu, Korea

Received 31 August 201430 September 2014 Accepted 10 November 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Antibiotics are among the most commonly prescribed medicines during pregnancies for various reasons. The antepartum use of antibiotics requires the consideration of maternal physiologic change, its effects to fetuses and drug-resistance. Usually, antibiotics are prescribed to pregnant women complicated with preterm labor, preterm premature ruptures of the membranes, urinary tract infection or sexually transmitted diseases. In this article, we reviewed the antepartum use of antibiotics in obstetrical management.

Keywords: Antibiotics, Pregnancy, Preterm labor, Preterm premature rupture of the membranes, Sexually transmitted disease

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Table 1.

Commonly used antibiotics during pregnancy

Beta-lactam
Penicillin
Natural	Penicillin G, V
Aminopenicllin	Ampicillin, amoxacillin
Peniciilin-beta lactamase inhibitor	Ampicillin-sulbactam, amoxicillin-clavulanic acid
Cephalosporins
1^st IV	Cefazolin
2^nd IV	Cefuroxime, cefoxitin, cefotetan, cefmetazole
3^rd IV	Cefotaxime, ceftizoxime, ceftriaxone, ceftazidime, cefoperazone, Cefpirome, cefepime
4^th IV	Cephalexin, cephradine, cefadroxil
1^st PO	Cefaclor, cefuroxime, cefprozil, loracarbef
2^nd PO	Cefpodoxime, cefixime
3^rd PO	Gentamycin
Aminoglycoside	Erythromycin, clarithromycin, azithromycin
Macrolide	Clindamycin
Lincosamide	Metronidazole
Nitromidazole

Abbreviation: IV, intravenous; PO, per oral.

Table 2.

Susceptibility of genital Mycoplasma to various antibiotics

Antibiotics	M. hominis	U. urealyticum	M. genitalium
Tetracyclines
Tetracycline	+	+	ND
Doxycycline	+	++	++
Macrolides
Erythromycin	-	++	++
Clarithromycin	-	++	++
Azythromycin	-	+	+++
Lincosamides
Clindamycin	+++	+	+
Quinolones	+
Ciprofolxacin	+	+	+
Ofloxacin	++	+	+
Moxifloxacin	++	++	++
Penicillins	-	-	-

Abbreviation: ND, no data.

Extremely sensitive, +++; highly sensitive, ++, sensitive, +; weakly sensitive, +; insensitive, -.

Table 3.

Oral antimicrobial agents used for treatment o pregnant women with asymptomatic bacteriuria

Single-dose treatment
Amoxicillin, 3 g
Ampicillin, 2 g
Cephalosporin, 2 g
Nitrofurantoin 200 mg
Trimthoprim-sulfamethoxazole, 320/1600 mg
Three-day course
Amoxicillin 500 mg three times daily
Ampicillin 250 mg four times daily
Ciprofloxacin 250 mg twice daily
Levofloxacin 250 mg or 500 mg daily
Nitrofurantoin 50 to 100 mg four times daily or 100 mg twice daily
Trimthoprim-sulfamethoxazole 160/800 mg two times daily
Other
Nitrofurantoin, 100 mg four times daily for 10 days
Nitrofurantoin, 100 mg twice daily for 5 to 7 days
Nitrofurantoin, 100 mg at bedtime for 10 days
Treatment failures
Nitrofurantoin, 100 mg four times daily for 21 days
Suppression for bacterial persistence or recurrence
Nitrofurantoin, 100 mg at bedtime for pregnancy remainder

Table 4.

Classes of antiretroviral drugs

Drug class	Category
Nucleoside/Nucleotide reverse transcriptase inhibitor
Lamivudine	Preferred
Zidovudine	Preferred
Abacavir	Alternative
Emtricitabine	Alternative
Tenofovir	Alternative
Didanosine	Special circumstances
Stavudine	Special circumstances
Non-nucleoside reverse transcriptase inhibitor
Nevirapine	Preferred
Efavirenz	Special circumstances
Etravirine	Insufficient data
Rilpivirine	Insufficient data
Protease inhibitors
Ritonavir	Preferred
Atazanavir	Preferred
Lopinavir/ritonavir	Preferred
Saquinavir	Alternative
Darunavir	Alternative
Indinavir	Alternative
Nelfinavir	Special circumstances
Fosamprenavir	Special circumstances
Tipranavir	Special circumstances
Entry inhibitors
Enfuvirtide	Insufficient data
Maraviroc	Insufficient data
Integrase inhibitors
Raltegravir	Special circumstances

Table 5.

Recommended treatment for pregnant women with syphilis

Category	Treatment
Early syphilis	Benzathine penicillin G, 2.5 million units intramuscularly as a single injection- some recommend a second dose 1 week later
More than 1-year duration	Benzathine penicillin G, 2.4 million units intramusculary weekly for three times
Neurosyphilis	Aqueous crystalline penicillin G, 3-4 million units intravenously every 4 hours for 10-14 days
	OR
	Aqueous crystalline penicillin G, 3-4 million units intramusculary daily, plus probenecid 500 mg orally four times daily, both for 10-14 days

Table 6.

Treatment of Chlamydia trachomatis infection during pregnancy

Regimen	Drug and Dosage
Recommended	Azithromycin 1g orally in a single dose
	Or
	Amoxicillin 500 mg orally three times a
	day for 7 days
Alternative	Erythromycin base 500 mg orally four
	times a day for 7 days
	Or
	Erythromycin base 250 mg orally four
	times a day for 14 days
	Or
	Erythromycin ethylsuccinate 800 mg
	orally four times a day for 7 days
	Or
	Erythromycin ethylsuccinate 400 mg
	orally four times a day for 14 days

Table 7.

Treatment of Gonococcal infections during pregnancy

Regimen	Drug and Dosage
Uncomplicated	Ceftriaxone, 250 mg intramuscularly as a single dose
	Plus
	Azithromycin, 1 g orally as a single dose
Disseminated gonococcal infection	Ceftriaxone 1 g IM or IV every 24 hours for 24 to 48 hours after improvement and oral cefixime 400 mg twice daily to complete at least 1 week of therapy

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