Antibiotics In Pregnancy – What to Have & What to Avoid

Antibiotics are the basic medication provided to treat fungal, viral and bacterial infections. Certain antibiotics are narrow-spectrum antibiotics (for example, penicillin) that kill a limited type of bacteria. Whereas other antibiotics are broad-spectrum (for example, tetracycline or ampicillin) and treat various illnesses that arise from bacterial infections. Antibiotics are commonly prescribed to everyone, but during pregnancy, a woman will want to know whether or not she should be taking them if required. While some antibiotics during pregnancy are safe and essential for treating bacterial infections, others may pose risks to fetal development. So, if you’re expecting and wondering which antibiotics are your pregnancy BFFs and which ones to ghost, keep reading.

Why Do You Need Antibiotics in Pregnancy?

A woman’s body undergoes a lot of changes during the nine months of pregnancy. As a woman’s immune system is weak during pregnancy, the chances of catching infections increase, and they may need to be treated with antibiotics, as leaving the illness untreated can pose a risk to the baby’s health. Using the right antibiotics during pregnancy can prove to be beneficial. But antibiotics should never be self-prescribed. If the need arises, the doctor may prescribe antibiotics even in the third trimester for a short duration.

Are Antibiotics Safe in Pregnancy?

Antibiotics vary in terms of the risk they pose during pregnancy. Some antibiotics are safe to use, but there are other antibiotics that can cause harm to the mother as well as the foetus and are not safe to use during pregnancy (1). If you’ve fungal or viral infections during pregnancy and you wish to treat it by taking antibiotics along with some other medication, you must check with your doctor and take the prescribed medicines.

How Safe Are Antibiotics During Pregnancy?

Antibiotics that are prescribed after assessing a woman’s condition during pregnancy will be safe for her. As all antibiotics are different and have different effects, your doctor will carefully subscribe you to the right medication. Besides, the side effects of any medication largely depend on the amount of medicine consumed, the span of time for which it is taken and the stage of pregnancy.

How Is the Safety of Antibiotics Ascertained?

Antibiotics are essential and have been used in pregnancy safely for years. The Food and Drug Administration (FDA) rates certain antibiotics in categories of A, B, C, D and X, based on their safety during pregnancy. Medications under A and B are usually considered to be safe for pregnant women (2). In 2011, the committee of the American Congress of Obstetricians and Gynaecologists (ACOG) validated the safety of antibiotics that are commonly prescribed in pregnancy. The conclusions were drawn based on the following:

• Investigations conducted on lab animals
• Studies on women using antibiotics and showing a low risk of birth defects
• Several years of use of antibiotics in obstetrics

List of Antibiotics That Are Safe in Pregnancy

In pregnancy, antibiotics should be used only when prescribed by the doctor. It is important to consult a medical professional to ascertain what antibiotics are safe during pregnancy.

Here’s a list of antibiotics you can take while pregnant (3) (4):

• Penicillin
• Amoxicillin
• Oxacillin
• Ampicillin
• Keflex
• Ancef
• Rocephin
• Gentamycin
• Neomycin
• Nitrofurantoin
• Clindamycin
• Cephalexin

Antibiotics to Avoid in Pregnancy

While antibiotics may be essential in some situations, is important to be aware that they may have certain side effects and may interfere with the body’s ability to fight illness. During pregnancy, some antibiotics affect the baby in the first and third trimesters, while some have their effect throughout pregnancy.

The following antibiotics classified under category D, are unsafe during pregnancy:

• Streptomycin and Kanamycin cause damage to the auditory nerve, leading to hearing loss in new-born (5).
• Tetracycline, Minocycline, Doxycycline and Oxytetracycline cause discolouration of baby’s teeth (6).
• Sulphonamide interferes with bile metabolism and transport in the baby’s liver and may also cause neonatal jaundice.
• Macrobid and Macrodantin affect the baby’s red blood cells.

Common Infections During Pregnancy That May Be Treated With Antibiotics

The most common infections faced during pregnancy that require a certain level of antibiotic treatment are:

• Vaginal Infections: Metronidazole is used to cure vaginal infections such as bacterial vaginosis and trichomoniasis. Earlier it was believed to cause congenital birth defects, but later it was declared safe (7).
• Urinary Tract Infection: This is a common condition faced by pregnant women. Antibiotics for urinary tract infection during pregnancy are (8):

1. 1. Nitrofurantoin (also termed Macrobid/Macrodantin) – This is recommended until 36 weeks of pregnancy as later it may adversely affect the foetus’s red blood cells.
   2. Trimethoprim (also termed Bactrim/Septa) – This medication often interferes with the absorption of folic acid and may cause a neural tube defect in the baby. It is recommended to be taken with a daily prenatal vitamin and a folic acid supplement, to cover the loss.

Precautions to Take While Having Antibiotics in Pregnancy

Researchers advise pregnant women to follow certain guidelines while taking an antibiotic. The following precautions are advisable for ensuring better health of the mother and baby:

1. Use an Antibiotic Only If No Alternate Treatment Suffices

Antibiotics while pregnant are generally not recommended except for some serious illness.

2. Choose Single Prescriptions Over Polypharmacy

Avoid combination medicines that are known to cure several symptoms at a go. As per research, such drugs often result in hypertension or high blood pressure in pregnant women.

3. Do Not Treat Viral Infections With Antibiotics

Antibiotics are ineffective in viral infections. Besides, overuse of antibiotics leads to drug-resistant bacteria, making them ineffective in the future.

4. Avoid Antibiotics During the First Trimester

Babies are most vulnerable during the first trimester when their organs and tissues are developing, so it’s suggested that you avoid taking antibiotics during the first trimester as they might cause potential complications and affect the health of the foetus.

5. Start With the Lowest Possible Effective Dose

Low dosage helps minimise drug accumulation and toxicity in the infant.

6. Do Not Use Over The Counter Medications During Antibiotic Treatment

Many over-the-counter medicines are not well tested for the safety of pregnant women. Do consult a doctor before taking any OTC medicine, vitamin or supplement.

7. Choose Safer Medication

Use proven and tested antibiotics (preferably tested on pregnant women).

FAQs

1. Do antibiotics affect breastfeeding after pregnancy?

Most antibiotics prescribed during pregnancy are also safe for breastfeeding. However, some may pass into breast milk in small amounts (9). If you are concerned, ask your doctor for alternatives that have minimal impact on your baby.

2. Can I take antibiotics for a cold or flu while pregnant?

No, antibiotics do not treat viral infections like the common cold or flu. They are only effective against bacterial infections. If you have a cold or flu, your doctor will recommend supportive care, such as rest, hydration, and pregnancy-safe medications for symptom relief.

Antibiotics and pregnancy require careful consideration, as some medications are essential for treating infections safely, while others can pose risks to the developing baby. Self-medication in any situation is best avoided, more so in pregnancy. Make sure you see a doctor for any ailment and only use medicines prescribed to ensure a smooth pregnancy and to protect your baby.

References/Resources:

1. Norwitz. E. R, Greenberg. J. A; Antibiotics in pregnancy: are they safe?; PubMed Central; https://pmc.ncbi.nlm.nih.gov/articles/PMC2760892/

2. Leek. J. C, Arif. H; Pregnancy Medications; National Library of Medicine; https://www.ncbi.nlm.nih.gov/books/NBK507858/

3. Bookstaver. P. B, Bland. C. M, Griffin. B, et al.; A Review of Antibiotic Use in Pregnancy; PubMed; https://pubmed.ncbi.nlm.nih.gov/26598097/

4. Pregnancy, breastfeeding and fertility while taking phenoxymethylpenicillin; NHS; https://www.nhs.uk/medicines/phenoxymethylpenicillin/pregnancy-breastfeeding-and-fertility-while-taking-phenoxymethylpenicillin/

5. USE OF AMINOGLYCOSIDE ANTIBIOTICS IN PREGNANCY; UKTIS; https://uktis.org/monographs/use-of-aminoglycoside-antibiotics-in-pregnancy/

6. Shutter. M. C, Akhondi. H; Tetracycline; National Library of Medicine; https://www.ncbi.nlm.nih.gov/books/NBK549905/

7. Sheehy. O, Santos. F, Ferreira. E, Berard. A; The use of metronidazole during pregnancy: a review of evidence; PubMed; https://pubmed.ncbi.nlm.nih.gov/25986038/

8. Urinary Tract Infections in Pregnant Individuals; American College of Obstetricians and Gynecologists; https://www.acog.org/clinical/clinical-guidance/clinical-consensus/articles/2023/08/urinary-tract-infections-in-pregnant-individuals

9. Breastfeeding and medicines; NHS; https://www.nhs.uk/conditions/baby/breastfeeding-and-bottle-feeding/breastfeeding-and-lifestyle/medicines/

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