Antibiotics in Pregnancy

Class B: No risk in controlled animal studies

A- Antifungal Topical Agents
Nystatin (Mycostatin)

B- Antiparasitic agents
Metronidazole or Flagyl (after first Trimester)
Avoid single dose therapy
Praziquantel - not in Briggs
Permethrin (topical) - not in Briggs (1998)

C- Anti-Tuberculosis agents
Ethambutol
Didanosine - not in Briggs (1998)

D- Antiviral agents
Nelfinavir - not in Briggs (1998)
Ritonavir
Saquinavir
Famciclovir
Valacyclovir

E- Antibiotics
All Cephalosporin Antibiotics (except Moxalactam)
All Erythromycin except Erythromycin Estolate
Azithromycin (Zithromax)
All Penicillin Antibiotics
Clindamycin
Macrodantin (before third trimester)
Sulfa antibiotics (before third trimester)

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Class C: Small risk in controlled animal studies

A- Antifungal agents
CDC recommends only Topical Antifungal in pregnancy
Avoid Antifungals in first trimester if possible
Terbinafine (Lamisil) - not in Briggs (1998)
Clotrimazole (Mycelex, Lotrimin)
Butoconazole (Femstat)
Miconazole (Monistat)
Amphotericin B
Fluconazole (Diflucan)
No fetal adverse effects seen in one study
King (1998) Clin Infect Dis 27:1151-60
Itraconazole (Sporanox)
Ketoconazole (Nizoral)
Teratogenic and Embryotoxic in animals
Griseofulvin
Teratogenic and Embryotoxic in animals

B- Antimalarial agents
Mefloquine (Lariam)
Chloroquine
Primaquine

C- Antiparasitic agents
Albendazole - not in Briggs (1998)
Ivermectin - not in Briggs (1998)
Mebendazole
Pentamidine
Thiabendazole
Pyrantel

D- Anti-Tuberculosis agents
Dapsone
Isoniazid (INH)
Pyrazinamide
Rifampin

E- Antiviral agents
Lamivudine
Stavudine
Zalcitabine
Zidovudine
Delavirdine - not in Briggs (1998)
Nevirapine
Indinavir
Cidofovir
Foscarnet
Ganciclovir
Acyclovir
Amantadine
Rimantadine
Interferon alpha

F- Antibiotics
Imipenem-Cilastin
All Fluoroquinolone antibiotics
Clarithromycin (Biaxin)
Pediazole - not in Briggs (1998)
Sulfisoxazole - not in Briggs (1998)
Trimethoprim
Vancomycin
Chloramphenicol
Gentamicin

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Class D: Strong evidence of risk to the human fetus

A- Antiparasitic agents
Metronidazole or Flagyl (First Trimester)
1- New evidence suggests first trimester safety
2- Burtin (1995) Am J Obstet Gynecol 172:525-9

B- Antibiotics
- Amikacin (Class D per manufacturer)
- Kanamycin
- Streptomycin
- Tobramycin (Class D per manufacturer)
- Sulfa (Third Trimester)
- All Tetracycline antibiotics (Doxycycline, Tetracycline and Minocycline)
- Erythromycin Estolate (llosone) - Due to hepatotoxicity in pregnant women
- Macrobid and Nitrofurantoin (Third Trimester)
1- Do not use either of these past 38 weeks
2- Can cause Hemolytic Anemia in newborns
3- Related to immature liver and G6PD Deficiency

C- Vaccines
Yellow Fever Vaccine

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Class X: Very high risk to the human fetus

A- Antimalarial agents
- Quinine

B- Antiviral agents
- Ribavirin
- Rebetron - not in Briggs (1998) 

C- Vaccines
- MeaslesVaccine
- Mumps Vaccine
- RubellaVaccine
- Small PoxVaccine
- TC-83 Venezuelan Equine EncephalitisVaccine
- Varicella Vaccine
1- Risk if vaccinated within 4 weeks of conception
2- Theoretic risk only; not an indication for EAB

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