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Antibiotics in Pregnancy, Lactation, and
Contraception

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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. Antimicrobials present risks to the pregnant woman (some of which are unique to pregnancy), as well as risks to the unborn fetus or breastfed infant. When antimicrobials are prescribed for women using hormonal contraceptives, there is a potential for interactions that may result in undesired (or at least unexpected) pregnancy. As medication therapy experts, pharmacists can provide guidance to prescribers by conveying the complexities of pregnancy and lactation risk data, and provide guidance to patients by summarizing the data in an understandable manner.

This issue will review considerations for safe use of antimicrobials in pregnancy and lactation, and discuss the known and potential effects of antimicrobials on hormonal contraceptive effectiveness. The principles of adverse drug effects in pregnancy and lactation are briefly reviewed, as well as the sources and limitations of data on the risks of antimicrobial use in these conditions. Tables 1 and 2 group commonly used oral antimicrobials into categories based on their risks in pregnancy and lactation, along with their current FDA pregnancy categories and Hale lactation risk ratings. Antiretrovirals to treat human immunodeficiency virus infection are not reviewed here, because they present a unique set of risk-benefit considerations. Following these sections is a discussion of mechanisms underlying the effects of antimicrobials on hormonal contraceptives; the table in the Patient Connection provides a summary of these interactions by drug and class.

Details

Publication Date: 09/18/2012
Expiration Date: 10/01/2015
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 and Conan MacDougall, PharmD, MAS, BCPS

Disclosure Statement

Dr. Chan and Dr. MacDougall report no financial or personal relationship with any commercial interest producing, marketing, reselling, or distributing a product or service 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. Discuss 4 types of adverse effects that can occur with prenatal exposure to antimicrobials and 3 factors that can affect the likelihood of adverse effects.

    2. Identify 5 antimicrobials that pose significant risks in pregnancy and/or lactation such that there would be few or no indications for their use.

    3. Counsel a patient on 2 strategies to limit the exposure of an infant to an antimicrobial if a woman chooses to continue breastfeeding while taking an antimicrobial.

    4. Recommend an appropriate management strategy for a patient taking a hormonal contraceptive product and an antimicrobial concurrently.

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: 0428-0000-12-010-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.

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