Antiinfective agents

Harineke Garbis, Margreet Rost van Tonningen, and Minke Reuvers

2.6.1

Penicillins

124

2.6.22

Griseofulvin

142

2.6.2

Cephalosporins

125

2.6.2 Î

Terbinafine

142

2.6.3

Other H-lactam antibiotics and

2.6.24

Malaria prophylaxis and

ß-lactamase inhibitors

126

therapy in pregnancy

143

2.6.4

Maerollde antibiotics

126

2.6.25

Chloroquine

144

2.6.5

Lincomycin and clindamycin

128

2.6.26

Proguanil

144

2.6.6

Tetracyclines

128

2.6.27

Mefloquine

145

2.6.7

Sulfanamides, trimethoprim,

2.6.28

Pyrimethamine, suifadoxine

atovaquone, and pentamidine

129

and dapsone

146

2.6.8

Quinolones

131

2.6.29

Quinine

147

2.6.9

Nitrofurantoin and other drugs

2.6.30

Halofantrine

148

for urinary tract infections

132

2.6.31

Primaquine

148

2.6.10

Aminoglycosides

133

2.6.32

Artemisinin derivatives

149

2.6.11

Chloramphenicol

134

2.6.33

Other malarial agents

150

2.6.12

Metronidazole and other

2.6.34

Tuberculosis and pregnancy

151

nitroimidazole antibiotics

135

2.6.13

polypeptide antibiotics

136

2.6.35

Isonlazid (INH)

152

2.6.14

Antimycotics in general

136

2.6.36

Rifampicin

153

2.6.15

Nystatin

137

2.6.37

Ethamhutol

153

2.6.16

Clotrimazole and miconazole

2.6.38

Pyrazinamide (PZA)

154

for topical use

137

2.6.39

Aminoglycosides in tuberculosis 154

2.6.17

Other local "conaiole"

138

2.6.40

Para •aminosalicylic acid (PAS)

154

antimycotics

2.6.41

Quinolones In tuberculosis

155

2.6.18

Other local antimycotics

138

2.6.42

Other second-line

2.6.19

"Conazole" antimycotics for

antituberculous drugs

155

systemic use

139

2.6.43

Dapsone

156

2.6.20

Amphotericin B

140

2.6.44

Aciclovir and other herpes

2.6.21

Flucytosine

141

antiviral;

156

2.6.45

Antiviral drugs for influenza

158

2.6.52

Niclosamide

164

2.6.46

Ribavirin

158

2.5.53

Praziquantel

165

2.6.47

Other antiviral drugs

159

2.6.54

Pyrantel

165

2.6.48

HIV prophylaxis and therapy

159

2.6.55

Ivermectin and

Mebendazole and flubendatole

diethylcarbamazine

166

2.6.49

162

2.6.56

Hyperthermia

166

2.6.50

Pyrviniumembonate

163

2.6.57

Traveling

168

2.6.51

Albendazole and thiabendazole

164

Pharmacology and toxicology

Penicillins belong to the 3-lac tain antibiotics. They inhibit cell-wall synthesis in bacteria and have bactericidal properties. Similar metabolic pathways do not exist in mammals, and therefore penicillins and related -¡-lactam antibiotics have a low toxicity profile for both the pregnant and non-pregnant patient when used in therapeutic doses. Only penicillin allergy may present a problem. In such cases, erythromycin is an alternative.

The group of penicillins includes amoxicillin, ampicillin, azidocillin, azlocillin, bacampicillin, cloxacillin, dicloxacillin, flucloxacillin, mezlocillin, nafcillin, oxacillin, panamecillin, penicillin G and V, phenoxymethylpenicillin, piperacillin, and propicillin. Penicillins arc sometimes used in combination with .-¡-lactamase inhibitors such as clavulanic acid, sulbactam, and tazobactam. Penicillins cross the placenta in low concentrations, and can be detected in amniotic fluid. Elimination of penicillins is more rapid in pregnant women, and therefore dosage or dosage intervals should be adjusted if necessary (Heikkila 1994, Chamberlain 1993).

There is no evidence that penicillins have teratogenic or embryo/fctotoxic properties (Berkovitch 2004, Jepsen 2003, Dencker 2002, Larsen 2001, 2000, Czeizel 2000A, 1998), Czeizel (2001A) found a higher prevalence of cleft palate after prenatal exposure to ampicillin in the second and third months of pregnancy, but they state that the risk is probably not real but due to chance. Pregnant women who are treated with penicillin for syphilis may develop the jarisch-Herxheimcr reaction - a febrile reaction, often with headache and myalgia. Fetal monitoring is recommended in such cases, as uterine contractions may occur (Myles 1998). There arc no differences between the various penicillins regarding their safety in pregnancy.

Recommendation. Penicillins can be safely used during pregnancy in the usual doses; they are the antibiotics of choice in pregnancy.

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