USE OF CEPHALOSPORINS IN PREGNANCY

Cephalosporins (commonly include: cefaclor, cefadroxil, cefalexin, cefazolin, cefixime, cefotaxime, cefpodoxime, cefradine, ceftazidime, ceftriaxone and cefuroxime) are a class of β-lactam antibiotics. Cephalosporins are broad-spectrum antibacterial agents used in the treatment of respiratory tract infections, otitis media, skin and soft tissue infections, urinary tract infections, sexually transmitted infections, septicaemia, meningitis, peritonitis, endocarditis, and in the prophylaxis of postoperative infections.

The majority of the available data on the use of cephalosporins in pregnancy do not suggest that therapeutic doses of these drugs are associated with an increased risk of miscarriage or congenital abnormalities. However, two studies have identified a possible association between in utero cephalosporin exposure and cardiovascular defects in exposed offspring, with single studies also suggesting an increased risk of oral clefts and anorectal atresia. A causal link between cephalosporin use in pregnancy and any congenital malformation remains to be proven.

Although data for other outcomes, such as preterm delivery, low birth weight, neonatal complications and neurodevelopmental impairment are reassuring, the studies which provide these data are extremely limited both in the number of exposed pregnancies and their methodology.

The results of culture and sensitivity tests should be available before making a treatment choice in accordance with local prescribing guidelines. However, if clinically indicated, cephalosporins may be used at any stage during pregnancy.

At the time of writing, the Royal College of Obstetricians and Gynaecologists (RCOG) advise routine intrapartum antibiotic prophylaxis for all women in preterm labour, with or without premature ruptured membranes. Benzylpenicillin should be used preferentially, substituted for a cephalosporin in patients with a non-severe penicillin allergy, or vancomycin where the allergy is severe.  

Exposure to cephalosporins at any stage of pregnancy is not 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.