Frågedatum: 1997-06-15
RELIS database 1997; id.nr. 13822, DRUGLINE
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Which antibiotics (tobramycin, gentamicin or imipenem/cilastatin) can be recommended to a pregnant



Fråga: Which antibiotics (tobramycin, gentamicin or imipenem/cilastatin) can be recommended to a pregnant woman (29th week) with pyelonephritis? The woman was born in 1974, and had a medical history of renal fibrosis on the left side and renal reflux on the right side. She has had repeated UTI since childhood. A pig tail catheter is inserted due to pyeolonephrithis.

Sammanfattning: The risk of ototoxicity in the fetus when the mother is treated with aminoglycosides for a short time and considering therapeutic drug monitoring,3 seems low. Concerning imipenem/cilastatin the experience of treatment in pregnancy is sparse. Treatment with aminoglycosides and/or imipenem/cilastatin may be applied when there is strong need in a pregnant woman with pyelonephritis.

Svar: Aminoglycosides have previously been recommended in the Swedish catalog of approved medical products to be strictly avoided in pregnancy especially during the first trimester due to suspected ototoxicity in the foetuses. However, the question concerning aminoglycosides is answered before in Drugline (1). It is concluded that the likelihood of the occurrence of an ototoxic effect in the fetus when the mother is treated with the currently available amionoglycosides and has therapeutic drug monitoring seems low.

There are no case reports on ototoxocity in children whose mothers have been treated with modern aminoglukosides or other drugs during pregnancy. This is based on the present written information obtained through literature searches and the lack of published cases (1).

Concerning imipenem/cilastatin the recommendation in FASS is B:3 - "clinical experience is sparse". In monkeys weight loss, diarrhea and fetal death have been seen in the offspring (2). A search in Medline resulted in information from Japanese studies concerning uneventful treatment in the perinatal period (abstracts, 3-10). According to personal communication with the company there are no cases reported about any malformations in children whose mothers took imipenem/cilastatin during pregnancy (11).

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