USE OF FLUCLOXACILLIN, PIPERACILLIN, TEMOCILLIN, AND TICARCILLIN IN PREGNANCY

Flucloxacillin, piperacillin, temocillin, and ticarcillin are broad-spectrum penicillin antibiotics indicated in the treatment of numerous mild to moderately severe infections caused by susceptible micro-organisms. Penicillin antibiotics can be used in pregnancy if clinically indicated.

No studies specifically investigating the risk of adverse pregnancy outcome following exposure to flucloxacillin, piperacillin, temocillin, or ticarcillin were located. A large body of evidence on penicillin antibiotics as a class shows no increased risk of congenital malformations, miscarriage, intrauterine death, low birth weight, preterm delivery, or neonatal complications following maternal exposure. Where possible associations with adverse outcomes have been suggested, findings are considered likely influenced by the effects of maternal infection during pregnancy.

The extensive body of data relating to prenatal use of penicillin antibiotics as a class does not indicate an increased risk of adverse fetal outcomes, although not all pregnancy outcomes have been studied in sufficient detail to fully exclude an increased risk. However, due to the potential adverse consequences of untreated maternal infection during pregnancy, the use of penicillin antibiotics, including those with limited or no pregnancy safety data, may be considered where clinically indicated.

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 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.

Exposure to flucloxacillin, piperacillin, temocillin, or ticarcillin 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.