Can You Take Antibiotics While Pregnant? A Pharmacist Explains

Antibiotics are medicines that are used to treat bacterial infections. They work by killing or slowing the growth of bacteria that cause disease. Antibiotics may be prescribed during pregnancy and delivery for a variety of reasons.

However, careful consideration is needed when weighing the benefits and risks of taking any medications, including antibiotics, during pregnancy. This is because some medicines can cross the placenta and harm the fetus.

Antibiotic Safety During Pregnancy

Can you take antibiotics while pregnant? Yes, you can; however, not all are considered safe. Your healthcare provider will help determine which one is best for you while keeping the following in mind:

• Frequency of antibiotics prescribed during pregnancy: About 25% of pregnant people are prescribed antibiotics. Up to 80% of prescriptions for pregnant people are written for antibiotics. However, data show that the more courses of antibiotics you take during pregnancy, the higher the risk of preterm birth.
• How medicines impact pregnancy: Some medications can reach a fetus by crossing the placenta. How much of the medicine reaches the fetus is an important consideration when choosing an antibiotic to minimize risks. In addition, antibiotics alter a pregnant person’s gut bacteria, which may also affect the developing fetus.
• FDA pregnancy categories: Many medicines haven’t been studied during pregnancy due to ethical concerns. Most clinical trials that study side effects and the safety of medicines exclude pregnant people out of caution. Only about 10% of the medicines approved since 1980 have enough data to gauge pregnancy risks. At one time, the Food and Drug Administration (FDA) established pregnancy categories for prescription medicines (A, B, C, D, and X) to help guide prescribers’ decisions. However, these categories are no longer used.
• Potential risks: Even antibiotics that are considered safe may be associated with increased risks of pregnancy complications, including preterm birth and low birth weight. However, researchers still don’t know whether the medicine or the infection itself is the root cause of these complications. Antibiotics during pregnancy may play a role in the development of conditions like asthma, eczema, or obesity in the baby, but more information is needed to know for sure.
• Gestational age: Taking antibiotics in the first or second trimesters poses an increased risk of preterm birth. Some medicines are safe in some trimesters but should be avoided in others.

You and your healthcare provider will weigh the benefits and risks of using any antibiotic against the risks the infection itself may pose to both you and your fetus.

Antibiotics Considered Safe During Pregnancy

Several antibiotics are generally considered safe during pregnancy. These include, but are not limited to, the following medicines:

• Penicillins: Examples of penicillins are Pen VK (penicillin), Amoxil (amoxicillin), and Augmentin (amoxicillin/clavulanate). These are the most commonly prescribed antibiotics during pregnancy; good safety data support their use. Because of changes in the body during pregnancy, you may need to take a higher dose of penicillin or take it more often to be effective.
• Cephalosporins: Examples of cephalosporins are Keflex (cephalexin), Ceftin (cefuroxime), and Rocephin (ceftriaxone). This class has been used in pregnant people for a long time and is often used in those who cannot take penicillin. Note that Rocephin is associated with risks to the developing fetus, including heart malformations and brain damage.
• Vancomycin: Vancomycin is often injected into a vein (intravenously or IV) for serious bacterial infections. It can also be taken by mouth. Although IV vancomycin does cross the placenta, it’s generally thought to be safe during the second and third trimesters of pregnancy. Note that there is a concern for kidney damage in the fetus.
• Macrobid (nitrofurantoin): This antibiotic acts exclusively in the urinary tract. It is generally considered safe for pregnant people with urinary tract infections (UTIs), although it should not be used in the third trimester.

Antibiotics to Avoid During Pregnancy

Antibiotics to avoid during pregnancy include, but are not limited to, the following:

• Fluoroquinolones: Examples of fluoroquinolones are Cipro (ciprofloxacin) and Levaquin (levofloxacin). This medication class has traditionally been avoided in pregnancy because studies in animals show that it can damage a fetus’s heart, kidneys, bones, and brain. Some newer studies suggest fluoroquinolones may be safe after the first trimester. Discuss the pros and cons of these antibiotics with your healthcare provider before use.
• Tetracyclines: Examples of tetracyclines are Minocin (minocycline) and Monodox (doxycycline). These medicines can slow fetal bone growth and cause a baby’s teeth to become discolored.
• Macrolides: Examples of macrolides are Zithromax (azithromycin), erythromycin, and Biaxin (clarithromycin). Conflicting information about pregnancy risks with these medicines exists. Some studies show a link between macrolide antibiotics and heart or genital deformities. Other research concludes the opposite, suggesting these antibiotics do not likely cause congenital disabilities. Your healthcare provider will help you weigh the benefits and risks of taking these medications.
• Bactrin (sulfamethoxazole/trimethoprim): This antibiotic is often prescribed for UTIs but should be avoided during pregnancy’s first and third trimesters. It may cause congenital disabilities, cleft palate, or miscarriage.

What to Do If I Unintentionally Take an Unsafe Antibiotic

If you unintentionally take an unsafe antibiotic during pregnancy or before you know you’re pregnant, do not panic. You can do the following to minimize risk:

• Contact your healthcare provider: They can help you determine the next steps, which might include additional monitoring of the fetus.
• Reach out to your pharmacist: Pharmacists are typically available after hours and are excellent resources on medication safety.
• Visit the MotherToBaby website: The Centers for Disease Control and Prevention (CDC) recommends this site. It has drug fact sheets in English and Spanish about specific medications and their safety during pregnancy. You can also call or chat online with an expert.

When Are Antibiotics Used During Pregnancy?

Antibiotics may play a vital role in ensuring the health and safety of both the pregnant person and fetus during pregnancy. Healthcare providers may prescribe these medications to treat a range of infections, including upper respiratory tract infections (URTIs), urinary tract infections (UTIs), sexually transmitted infections (STIs), bacterial vaginosis, and group B streptococcus.

If left untreated, such infections can pose significant risks, leading to complications like miscarriage, premature birth, low birth weight, and even stillbirth.

In addition to their use during pregnancy, antibiotics may also be necessary during labor and delivery to address certain medical situations. For instance, preterm delivery, the presence of fever during labor, or the need for a cesarean section are possible reasons for antibiotic use.

Ultimately, the judicious use of antibiotics is essential for managing infections that may otherwise jeopardize the well-being of both the pregnant person and their child. Ensuring timely and appropriate treatment is crucial for promoting positive pregnancy outcomes.

Managing Infections During Pregnancy

Keep in mind that the immune system is suppressed (less active) during pregnancy. This immune suppression prevents a pregnant person’s body from rejecting the fetus. Knowing that pregnant people may be more prone to infections can help you proactively optimize your health. Tips to keep in mind include the following:

• Prevention: Good hygiene is crucial to minimize infection risks. As much as possible, try to avoid contact with people who are sick. In addition, some lifestyle changes can help prevent infections, including getting recommended vaccines, preparing food carefully, avoiding unpasteurized foods and milk, wearing bug repellent, and washing your hands after contact with pets or litter boxes. If you’re prone to UTIs, consider prevention tips such as voiding the bladder after sexual intercourse, or ask your healthcare provider if drinking cranberry juice is worth a try.
• Recognize symptoms: Signs of bacterial infections during pregnancy can vary. They are often nonspecific, meaning they could also be due to other causes. Symptoms of infection during pregnancy may include fever, headache, fatigue, or gastrointestinal symptoms like diarrhea or stomach pain. If you experience these or other changes that concern you, contact your healthcare provider immediately.
• Monitoring: Regular checkups are essential for monitoring maternal and fetal health. Keep up with scheduled appointments with your healthcare providers and reach out promptly when any concerns arise. If you develop an infection, you may be monitored more frequently.

Other Considerations

Not every infection will respond to antibiotics. Importantly, they aren’t effective against viruses like colds, the flu, or COVID-19.

The following considerations can help you decide if an antibiotic is your best choice:

• Importance of medical advice: Always consult a healthcare provider before taking any medication during pregnancy. Remember that “medication” also includes supplements like herbs and vitamins as well as over-the-counter (OTC) medicines.
• Alternatives: Effective diagnosis and treatment are crucial during pregnancy. If you’re unsure, don’t rely on self-diagnosis and treatment alone. Depending on what’s causing your symptoms, potential non-antibiotic treatments could include hydration, rest, humidifiers, or OTC medications.

Summary

Antibiotics may be prescribed during pregnancy to treat infections such as UTIs or respiratory tract infections. They may also be given during labor and delivery.

When choosing an antibiotic, your healthcare provider will consider factors like whether the medicine crosses the placenta and the risks of infection compared to the risks of taking the antibiotic.

In general, penicillins and cephalosporins are considered safe during pregnancy. Fluoroquinolones and tetracyclines are typically not recommended.

During pregnancy, a person is more susceptible to infections. You can minimize risks during this time by practicing good hygiene, getting recommended vaccinations, and safely preparing foods. Do your best to keep up with regularly scheduled visits with your healthcare provider. Reach out promptly if you have any concerns about an infection.