USE OF AMOXICILLIN AND CO-AMOXICLAV IN PREGNANCY

Amoxicillin is a broad-spectrum penicillin antibiotic indicated for the treatment of sinusitis, otitis media, streptococcal tonsillitis and pharyngitis, pneumonia, cystitis, asymptomatic bacteriuria in pregnancy, acute pyelonephritis, typhoid and paratyphoid fever, dental abscess with spreading cellulitis, Helicobacter pylori eradication, and Lyme disease. It is available in combination with clavulanic acid to prevent inactivation by beta-lactamase enzymes such as co-amoxiclav.

A large body of data indicates no increased risk of congenital malformations, miscarriage, intrauterine death, low birth weight (LBW), preterm delivery, or neonatal complications following maternal exposure to amoxicillin or co-amoxiclav. Where possible associations with adverse outcomes have been suggested, findings are considered likely influenced by the effects of infection during pregnancy.

Where possible, the results of culture and sensitivity tests should be available before making a treatment choice in accordance with local prescribing guidelines. It is important to ensure adequate treatment of infection in order to avoid adverse maternal and fetal effects resulting from uncontrolled infection or pyrexia.

The Royal College of Obstetricians and Gynaecologists (RCOG) advises routine intrapartum antibiotic prophylaxis (IAP) for all women in preterm labour, with or without pre-labour rupture of membranes (PROM). Benzylpenicillin should be used preferentially, but a cephalosporin should be used in women with a non-severe penicillin allergy, or vancomycin where the allergy is severe. The National Institute for Health and Care Excellence (NICE) guidelines also state that women with pre-labour PROM should be offered oral erythromycin (250mg, 4 times a day) for a maximum of 10 days or until the woman is in established labour (whichever is sooner), with oral penicillin offered to women who cannot tolerate erythromycin.

Co-amoxiclav should not be used in women with pre-labour PROM owing to a possible increased risk of necrotising enterocolitis (NEC) in the neonate.

Exposure to amoxicillin/co-amoxiclav at any stage in pregnancy would not usually be regarded as medical grounds for termination of pregnancy or any additional fetal monitoring. However, other risk factors may be present in individual cases which may independently increase the risk of adverse pregnancy outcome. Clinicians are reminded of the importance of consideration of such factors when performing case-specific risk assessments.