Antibiotics in Pregnancy, Lactation, and Contraception
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.
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.
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.
Dominic Chan, PharmD, BCPS and Conan MacDougall, PharmD, MAS, BCPS
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.
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.
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
Editorial and Review Board
Chief Editor and CE Administrator
Terry M. Baker, PharmD
Tracy Farnen, PharmD
James Chan, PharmD, PhD
Pharmacy Quality and Outcomes Coordinator
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
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
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
Visiting Associate Professor and Lecturer
Samuel Merritt University
Pamela Mausner, MD
Helen Berlie, Pharm.D. CDE, BCACP
Clinical Assistant Professor, Pharmacy Practice
Wayne State University
Ambulatory Care Specialist - Diabetes
Health Centers Detroit Medical Group
Senior Editorial Advisor
Gerard Hatheway, PharmD, PhD
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
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.
Any hardware that supports Microsoft Windows, Apple Mac OS, iOS, or Android, and meets the 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.
Required. Broadband recommended. (T1, DSL, Cable, G4 or higher.)