Principles of Anti-Infective Dosing in Pregnancy

• Published in: Clinical therapeutics Vol. 38; no. 9; pp. 2006 - 2015
• Main Authors: Patil, Avinash S., MD, Sheng, Jessica S., MD, Dotters-Katz, Sarah K., MD, Schmoll, Maria S., MD, Onslow, Mitchell L., MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.09.2016; Elsevier Limited
• Subjects: Anti-Bacterial Agents - administration & dosage; Anti-Bacterial Agents - pharmacokinetics; Anti-Bacterial Agents - therapeutic use; Anti-Infective Agents - administration & dosage; Anti-Infective Agents - pharmacokinetics; Anti-Infective Agents - therapeutic use; Antibiotics; Antiinfectives and antibacterials; Blood; Breastfeeding & lactation; Cefazolin; Drug dosages; Drugs; FDA approval; Female; Humans; Immunization; Infections; Influenza; Internal Medicine; Literature reviews; Medical Education; Mens health; Metabolism; Neonates; Pharmacodynamics; Pharmacokinetics; Pharmacology; Pregnancy; Pregnancy Complications, Infectious - drug therapy; Pregnancy Complications, Infectious - metabolism; Prenatal Care - methods; Reviews; Surgery; Surgical site infections; Surgical Wound Infection - drug therapy; Surgical Wound Infection - metabolism; Vaccines; Womens health; United States > US; pharmacokinetics; vaccines; antibiotics; pregnancy
• ISSN: 0149-2918; 1879-114X
• DOI: 10.1016/j.clinthera.2016.08.005

Abstract Purpose Anti-infectives are among the most commonly prescribed medications in pregnancy. However, detailed information on the pharmacokinetics and pharmacodynamics of these medications in pregnancy is limited, leading to uncertainty among clinicians regarding the tolerability and efficacy of treatments. The purposes of this review were to highlight key physiologic changes during pregnancy that influence drug behavior, and to discuss areas of active research related to anti-infective drugs in pregnancy. Methods A review of literature in PubMed was performed for topics related to physiologic changes of pregnancy, postcesarean surgical site infections, vaccines in pregnancy, and intrauterine infections. The literature was reviewed and pertinent sources were utilized for this article. Findings Physiologic changes during pregnancy may impact drug disposition and efficacy. Cefazolin regimens are the current prophylactic treatment of choice for postcesarean surgical site infections. Vaccines are provided in pregnancy for both maternal and neonatal benefit. Broad-spectrum antibiotics continue to be used as first-line therapy for intrauterine infections. Implications Continued efforts to broaden the knowledge base on anti-infective drug behavior in pregnancy will result in increased therapeutic options for this population.