The following treatment options are meant as guidelines for prescribers, they do not replace clinical judgment but augment it. These prescribing guidelines have been developed after review of national and international guidelines and current practice, expert opinion, clinical consensus and published evidence where it exists.
Before prescribing antimicrobials for pregnant women, clinicians should also consider the following:
- Local antimicrobial sensitivities and resistance data.
- Previous antimicrobial treatment the woman has been prescribed for the current and previous infections during this pregnancy
- The allergy status of the woman
- Exposure of the fetus to the prescribed antimicrobial and its possible teratogenicity
- Concurrent medication that the woman is taking
- The stage of pregnancy
- Concurrent morbidities
It is important to recognise that antibiotics should be administered during pregnancy at the upper end of their suggested dosing ranges, as pregnant women have an increased GFR and volume of distribution ranges are higher e.g. for strep tonsillitis use 666 mg dose calvapen rather than 333mg dose.
The excretion of most drugs in breast milk is low but the possibility should be discussed with mothers and latest guidance checked on individual drugs SmPC on the HPRA website, www.hpra.ie. The National Institute of Health in the USA have a useful app called "LactMed" which may provide other useful information on safety in breastfeeding.
Remind patients to avail of recommended immunisations during pregnancy Influenza and pertussis as per national immunisation guidelines.Those found susceptible to rubella should receive MMR post pregnancy https://www.hse.ie/eng/health/immunisation/pubinfo/pregvaccs/
The conditions listed below are either pregnancy specific conditions that a GP may need initiate antimicrobial therapy e.g. post partum endometritis
Or a non-pregnancy specific infection that occurs in a pregnant woman e.g. influenza
Gps needed to consider that any female of childbearing age could be pregnant when prescribing antimicrobials.
Click here to see our page on Pregnancy infections
Remind patients to avail of recommended immunisations during pregnancy Influenza and pertussis as per national immunisation guidelines, https://www.hse.ie/eng/health/immunisation/pubinfo/pregvaccs/
Visit HPSC Information Leaflets pages for the General Public, (MRSA, CRE, etc)
Reviewed May 2019