Safe antibiotics during pregnancy
Antibiotics should be used with caution during pregnancy. These four antibiotics are well known and used in pregnancy. However, in the case of the multi-resistant bacterial strain, carbapenems, monobactams are possible options even if they have to be administered on a risk-benefit basis.
Nitrofurantoin has been used extensively and is considered safe to use during pregnancy. The possible haemolytic anaemia in the newborn does not allow the use of Nitrofurantoin during delivery or near term. We can effectively treat non-symptomatic bacteriuria and acute cystitis with Nitrofurantoin. However, it is not appropriate for treating pyelonephritis because it does not achieve adequate tissue penetration.
Although trimethoprim is commonly used to treat symptomatic UTIs, good evidence to support its use in pregnancy is lacking. However, it is not thought to be teratogenic. It is recommended that trimethoprim is avoided if possible in the first trimester because it is a folic acid antagonist and theoretically may increase the risk of neural tube defects.
Cephalosporins are considered safe to use in pregnancy. However, the use of broad-spectrum antibiotics (such as cephalosporins) should be avoided. In fact, there are concerns that broad-spectrum antibiotics increase the risk of Clostridium difficile, methicillin-resistant Staphylococcus aureus (MRSA) and resistant UTIs. C. difficile infection can be life-threatening in pregnant women, and there are case-reports of both maternal deaths and stillborn infants.
All penicillins are considered safe to use during pregnancy, however, there is evidence that bacterial resistance to amoxicillin is high. For this reason, Amoxycillin is not suitable as empiric therapy for acute cystitis but can be used if urine culture shows susceptibility.