ANTIBIOTICS IN PREGNANCY

Modified pharmacokinetics: Serum concentrations of antibiotics vary wi th individuals and pregnancy term but are generally lower and theoreti cally dosage should be increased. Betalactames: This class includes pe nicillins and cephalosporins considered to be safe for pregnant women. These antibiotics should be used against urinary infections, listerio sis, syphilis, patent ovum infections, endometritis and as prophylasis in case of cesarean section. Aminoglycosides: This class should not b e prescribed as first intention therapy due to tile risk of ototoxicit y and renal toxicity. Tetracyclines: Should not be used during pregnan cy. Macrolides: Erythromycin prescribed for Chlamydia infections may b e poorly tolerated (digestive disorders) and corsses the placental bar rier less well than betalactames. Spiramycine has been shown to be rot ary safe both for the pregnant woman and the fetus and is indicated in case of toxoplasmosis seroconversion, depending on term at contaminat ion. Other antibiotics: Metronidazole, indicated for Trichimonas infec tions, should be avoided during the first trimester and at the termina l stage of pregnancy. Quinolones are contraindicated. Sulfamides are a lso contraindicated during the first trimester. The pyrimethamine-sulf adiazine combination is the most effective treatment for toxoplasmosis . Nitrofuranes can cause hemolytic anemia in women with glucose-6-phos phate dehydrogenase deficiency. Active tuberculosis during the first t rimester of pregnancy should betreated with isoniazid and ethambutol. (C) 1997, Masson, Paris.