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Anti-infectives. (Drugs, Pregnancy, and Lactation).
This is the second installment of a three-part series of columns on the safety of antibiotics in pregnant and lactating women.
* Lincosamides. Clindamycin (Cleocin) has been classified under pregnancy category B. There is no evidence of teratogenicity or embryo-ferotoxicity from exposure during any stage of gestation. This drug is commonly used during pregnancy and is safe to use during breast-feeding.
* Quinolones and fluoroquinolones. Of the older quinolones, nalidixic acid (NeGram) is rated category C. Nalidixic acid is still used to treat urinary tract infections but not widely It is teratogenic and embryocidal in rats when given at about six times the human dose. It should therefore be avoided in the first trimester if possible, but there is no evidence of fetal harm in humans. Cinoxacin (Cinobac) is rated category B, but there are no fetal risk or breast-feeding data on this drug.
All 10 of the currently available fluoroquinolones are rated C. These include ciprofloxacin (Cipro), enoxacin (Penetrex), gatifloxacin (Tequin), 1evofloxacin (Levaquin), lomefloxacin (Maxaquin), moxifloxacin (Avelox), norfloxacin (Noroxin), ofloxacin (Floxin), and sparfioxacin (Zagam). They are not teratogenic or embryofetotoxic in rats, but they have been shown to have toxic effects (abortions and stunted growth) in rabbits exposed in utero to doses at or close to maternal toxic doses. But in observational studies in pregnant women, no association between fluoroquinolones and birth defects has been found.
All quinolones and fluoroquinolones can induce arthropathies in immature animals when given directly, and there have been case reports of lesions in cartilage in human children who have taken fluoroquinolones.
Based on the limited data, the safest course is to avoid these drugs during pregnancy. There usually are safer alternatives available, and they are not a primary drug for any infection commonly seen in pregnancy (with the exception of anthrax). If exposure occurs, however, pregnancy termination is not warranted.
For nursing women, there is the theoretical risk of arthropathies in babies exposed to the drugs in breast milk and the known risk of phototoxicity. Phototoxicity has been reported in adults on these drugs, and squamous cell carcinoma has been reported in infant mice exposed chronically to some fluoroquinolones and ...
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- Anti-Infectives. (Drugs, Pregnancy, And Lactation).(Brief Article)
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...adults on these drugs, and squamous...Aminoglycosides. The drugs in this class...ototoxicity and renal toxicity in adults. Kanamycin...exposed to the drug in utero. High...Ototoxicity and renal toxicity may potentially...or nephrotoxic drugs should be avoided...
Source: HighBeam Research, Anti-infectives. (Drugs, Pregnancy, and Lactation).