Non Subscriber: Buy This Issue

Antibiotics in Pregnancy and Lactation

Clicking the "View this Article" button will open the issue as a resizable PDF. To take the test for the issue, return to this Introduction page and click the "Take the Test" button. The Introduction page will remain open after you open this issue.
You may need to re-size or close the issue in order to see the Introduction page.

Overview

Antimicrobials are among the most commonly used drugs in pregnancy and lactation. They are prescribed for a variety of infections during or following pregnancy, including urinary tract infections, Group B streptococcal colonization, and mastitis. In a recent Centers for Disease Control survey, 30% of women reported taking antibiotics during pregnancy. Antimicrobials can present risks to the pregnant woman (some of which are unique to pregnancy), as well as risks to the unborn fetus or breastfed infant.

In December 2014, the FDA approved new medication labeling requirements for pregnancy and lactation that began to take effect in June 2015. This issue discusses the new labeling, and updates the previous (October 2012) Rx Consultant issue on antimicrobial use in pregnancy and lactation. The principles of adverse drug effects in pregnancy and lactation will be also discussed. Tables 1 and 2 group selected oral antimicrobials into categories based on perceived risks in pregnancy and lactation, with their "retired" FDA pregnancy categories and lactation risk ratings (based on the Hale lactation rating scale), along with commentary. Definitions of the risk categories for both pregnancy and lactation are provided in the appendix of the online version of this issue. Antiretroviral agents for the treatment of HIV infection and hepatitis are not reviewed here because they present a unique set of risk-benefit considerations.

A summary of potential antimicrobial/hormonal contraceptive interactions and counseling advice for patients is provided in the Patient Connection interpretation and prescribing practices. While more detailed information will be available to help guide providers who care for pregnant and breastfeeding patients, the new system also imparts greater responsibility to healthcare providers to protect the mother, unborn fetus, or breastfed baby.

Details

Publication Date: 02/23/2016
Expiration Date: 02/23/2019
CE Credit: 1.5 (0.15 CEU)
Type of Activity: Knowledge-based

This program was developed by The Rx Consultant and published by Continuing Education Network, Inc. The Rx Consultant accepts no advertising or financial support from the pharmaceutical industry and is funded solely by the purchase of programs. The Rx Consultant is dedicated to providing unbiased, balanced information to health care practitioners.

Programs developed by The Rx Consultant are written by health care providers with expertise in the topic area, peer-reviewed, extensively edited, and fact-checked. This development process was created to insure that every program presents information that is current, accurate, relevant to "real world" health care providers, and written in an easy reading, "plain English" style.

Authors

Dominic Chan, PharmD, BCPS, is the Pharmacy Clinical Coordinator – Antimicrobial Stewardship, Legacy Health and an Infectious Diseases and Antimicrobial Stewardship specialist at Legacy Emanuel Medical Center in Portland, Oregon.
Kerri Norman, RPh is the NICU/Women’s Services Lead Pharmacist at Randall Children’s Hospital, Legacy Emanuel Medical Center in Portland, Oregon.

Disclosure Statement

Disclosure: Dr. Chan and Ms. Norman report no financial relationship with the manufacturer(s) or provider(s) of any commercial product(s) or service(s) that appears in this issue.

Target Audience

This accredited program is targeted to pharmacists and nurses.

Goals & Objectives

At the conclusion of this program, participants will be able to:

    1. Describe 6 types of adverse effects that can occur with prenatal exposure to antimicrobials, and list factors that may increase the risk. Discuss the new labeling requirements for pregnancy and lactation, and the expected impact on clinical practice.
    2. Identify 4 antimicrobials that pose significant risks in pregnancy and/or lactation such that there would be few or no indications for their use in a pregnant or breastfeeding woman.
    3. Counsel a mother on strategies to limit her infant’s exposure to an antimicrobial taken during breastfeeding.
    4. Recommend appropriate management for a patient taking an antimicrobial while using a hormonal contraceptive.

Accreditation Statements

The Rx Consultant is a publication of Continuing Education Network, Inc.

Continuing Education Network, Inc. is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education as a provider of continuing pharmacy education.

Continuing Education Network is approved by the California Board of Registered Nursing, Provider Number CEP 13118. Programs approved by CA BRN are accepted by most State Boards of Nursing.

ACPE Universal Activity Number: 0428-0000-16-002-H01-P


Exam & Credit Statement Procedures

Upon successful completion of this program and the post test (70%), 1.5 hours of continuing education credit will be awarded. To receive credit and your exam score, please complete the exam questions and program evaluation.

Editorial and Review Board

Chief Editor and CE Administrator


Terry M. Baker, PharmD

Managing Editor


Tracy Farnen, PharmD

Associate Editors


James Chan, PharmD, PhD
Pharmacy Quality and Outcomes Coordinator
Kaiser Permanente
Oakland, CA

Associate Clinical Professor
School of Pharmacy
University of California San Francisco
San Francisco, CA

Richard Ron Finley, B.S. Pharm.,R.Ph.
Clinical Pharmacist (volunteer faculty)
University of California, San Francisco (UCSF) Memory and Aging Center
Lecturer (Emeritus) UCSF, Department of Clinical Pharmacy
Health Sciences Clinical Professor, UCSF School of Pharmacy
San Francisco, CA

Consultant Pharmacist
Ray Dolby Brain Health Center, Sutter Health/CPMC
San Francisco, CA

Consult Pharmacist Aging and Adult Health Services
San Francisco Health Department
San Francisco, CA

Julio R. Lopez, PharmD, FCSHP
Chief of Pharmacy Service
VA Northern California Health Care System

Adjunct Clinical Professor
College of Pharmacy
Touro University
Vallejo, CA

Assistant Clinical Professor
School of Pharmacy
University of California, San Francisco
San Francisco, CA Adjunct Professor
Thomas J. Long School of Pharmacy
University of the Pacific
Stockton, CA

Visiting Associate Professor and Lecturer
Nursing School
Samuel Merritt University
Oakland, CA

Pamela Mausner, MD

Helen Berlie, Pharm.D. CDE, BCACP
Clinical Assistant Professor, Pharmacy Practice
Wayne State University
Detroit, MI

Ambulatory Care Specialist - Diabetes
Health Centers Detroit Medical Group
Detroit, MI

Senior Editorial Advisor


Gerard Hatheway, PharmD, PhD

Editorial Advisors


Belinda M. Danielson, RPh
Christopher M. DeSoto, PharmD
Angie S. Graham, PharmD
Cynthia Chan Huang, PharmD, MBA
Fred Plageman, PharmD

Editorial Advisor and Clinical Practice Consultant for Nurse Practitioners


Emily K.
Meuleman, RN, C, MS

About the Rx Consultant

The Rx Consultant is a monthly publication dedicated to providing health care professionals with the information they need to educate patients about drugs and manage drug therapy. The reader is responsible for confirming the information presented here and interpreting it in relation to each patient's specific situation before utilizing the information.

Technical Specifications

Hardware requirements

Any hardware that supports Microsoft Windows, Apple Mac OS, iOS, or Android, and meets the software requirements.

Software requirements

Browser that supports TLS 1.1 + and PDF files.

This includes Microsoft Internet Explorer 11, Google Chrome 38, Google Android OS 5.0 Browser, Apple Safari (version 7 for desktop, 5 for mobile), Mozilla Firefox 27, newer versions of these browsers, as well as some earlier versions that may require additional configuration.

Adobe Acrobat Reader is recommended, and is required for some browsers.

Note: TLS 1.1 and 1.2 support is required for browser security. Click here for TLS browser support details.

Internet Connectivity

Required. Broadband recommended. (T1, DSL, Cable, G4 or higher.)

Contact Us

Exam Processing Inquiries

The Rx Consultant
rxmail@rxconsultant.com
1-800-798-3353

Educational Content Inquiries

The Rx Consultant
editor@rxconsultant.com
1-800-798-3353

Non Subscriber: Buy This Issue