ANTIFUNGAL THERAPY DURING PREGNANCY

Careful consideration of the benefit to the mother and the risk to the fetus is required when prescribing antifungal therapy in pregnancy. I midazoles are considered safe as tropical therapy for fungal skin infe ctions during pregnancy. Nystatin is minimally absorbed and is effecti ve for vaginal therapy. Although vaginal use of the imidazoles is prob ably safe during the later stages of pregnancy, their systemic absorpt ion is higher than when applied to the skin. The systemic antifungal d rug with which there has been the most experience in pregnancy is amph otericin B. There have been no reports of teratogenesis attributed to this agent. There is evidence to suggest that fluconazole exhibits dos e-dependent teratogenic effects; however, it appears to be safe at low er doses (150 mg/day). Ketoconazole, flucytosine, and griseofulvin hav e been shown to be teratogenic and/or embryotoxic in animals. Iodides have been associated with congenital goiter and should not be used dur ing pregnancy.