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1461. Ciprofloxacin

, moxifloxacin, nalidixic acid, norfloxacin and ofloxacin) are broad-spectrum synthetic antibiotics used in the treatment of a wide variety of infections including those of the urinary tract, respiratory-tract, gastro-intestinal system, bones and joints, as well as gonorrhoea, chlamydia and septicaemia. Ciprofloxacin is also used in the treatment or post-exposure prophylaxis of anthrax. No increased risk of congenital malformations overall, low birth weight, preterm delivery, intrauterine death or neonatal (...) complications have been found for in utero exposure to quinolone antibiotics when studied as a class. Data on offspring malformation risk for individual quinolones are generally limited. Single studies have suggested an association between in utero quinolone exposure and conotruncal defects and Tetralogy of Fallot, and in utero nalidixic acid exposure and infantile pyloric stenosis, however these findings were based on a small number of exposed infants with these anomalies. One study found an increased risk

2014 UK Teratology Information Service

1462. Chloramphenicol

Chloramphenicol USE OF CHLORAMPHENICOL IN PREGNANCY 0344 892 0909 USE OF CHLORAMPHENICOL IN PREGNANCY (Date of issue: February 2016 , Version: 3 ) This is a UKTIS monograph for use by health care professionals. For case-specific advice please contact UKTIS on 0344 892 0909. To report an exposure please download and complete a . Please encourage all women to complete an . Summary Chloramphenicol is a broad spectrum antibacterial. Due to the risk of serious haematological side effects, systemic

2014 UK Teratology Information Service

1463. Cephalosporins

, cefadroxil, cefalexin, cefixime, cefotaxime, cefpodoxime, cefradine, ceftazidime, ceftriaxone and cefuroxime) are a class of β-lactam antibiotics originally derived from the Acremonium fungus. 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

2014 UK Teratology Information Service

1464. Carbapenems

Carbapenems USE OF CARBAPENEMS IN PREGNANCY 0344 892 0909 USE OF CARBAPENEMS IN PREGNANCY (Date of issue: January 2016 , Version: 1 ) This is a UKTIS monograph for use by health care professionals. For case-specific advice please contact UKTIS on 0344 892 0909. To report an exposure please download and complete a . Please encourage all women to complete an . Summary The carbapenems are broad-spectrum beta-lactam antibacterials that include ertapenem, imipenem and meropenem. Imipenem (...) and meropenem are used for the treatment of severe hospital-acquired infections and polymicrobial infections. Ertapenem is used for the treatment of abdominal and gynaecological infections, pneumonia, and skin and soft tissue foot infections in patients with diabetes. Unlike the other carbapenems, ertapenem is not active against Pseudomonas or against Acinetobacter spp . There is extremely limited information on the use of carbapenem antibiotics during pregnancy and an evidence-based evaluation of risk

2014 UK Teratology Information Service

1465. Benzylpenicillin

Benzylpenicillin USE OF BENZYLPENICILLIN IN PREGNANCY 0344 892 0909 USE OF BENZYLPENICILLIN IN PREGNANCY (Date of issue: June 2012 , Version: 2 ) This is a UKTIS monograph for use by health care professionals. For case-specific advice please contact UKTIS on 0344 892 0909. To report an exposure please download and complete a . Please encourage all women to complete an . Summary Benzylpenicillin, a beta-lactam antibiotic for parenteral use, is primarily active against gram positive bacteria

2014 UK Teratology Information Service

1466. Azithromycin

Azithromycin USE OF AZITHROMYCIN IN PREGNANCY 0344 892 0909 USE OF AZITHROMYCIN IN PREGNANCY (Date of issue: June 2017 , Version: 2.1 ) This is a UKTIS monograph for use by health care professionals. For case-specific advice please contact UKTIS on 0344 892 0909. To report an exposure please download and complete a . Please encourage all women to complete an . A corresponding patient information leaflet on is available at . Summary The macrolide antibiotics include azithromycin, clarithromycin (...) , erythromycin, spiramycin and telithromycin. Macrolides have an antibacterial spectrum similar to that of penicillin and are thus considered an alternative in penicillin-allergic patients. Indications include sinusitis, otitis media, pharyngitis, tonsillitis, bronchitis, skin and soft tissue infection. Azithromycin is also used in the treatment of chlamydia, and clarithromycin in the eradication of Helicobacter pylori . The considerable data for macrolides as a class, and for erythromycin specifically, do

2014 UK Teratology Information Service

1467. Ampicillin

Ampicillin USE OF AMPICILLIN IN PREGNANCY 0344 892 0909 USE OF AMPICILLIN IN PREGNANCY (Date of issue: June 2012 , Version: 2 ) This is a UKTIS monograph for use by health care professionals. For case-specific advice please contact UKTIS on 0344 892 0909. To report an exposure please download and complete a . Please encourage all women to complete an . Summary Ampicillin is a beta-lactam antibiotic with a broad spectrum of activity. Data on ampicillin exposures in pregnancy do not indicate

2014 UK Teratology Information Service

1468. Amoxicillin

Amoxicillin USE OF AMOXICILLIN IN PREGNANCY 0344 892 0909 USE OF AMOXICILLIN IN PREGNANCY (Date of issue: September 2014 , Version: 2.1 ) This is a UKTIS monograph for use by health care professionals. For case-specific advice please contact UKTIS on 0344 892 0909. To report an exposure please download and complete a . Please encourage all women to complete an . A corresponding patient information leaflet on is available at . Summary Amoxicillin is a broad spectrum β-lactam antibiotic used

2014 UK Teratology Information Service

1469. Corrosives

symptoms observed as a result of exposure is likely to be a major determinant of fetal effects. It is therefore important to treat the mother appropriately to reduce the risks of maternal, and as a consequence, fetal toxicity. If a specific treatment is required, it should not be withheld on account of pregnancy. Where alternatives exist, UKTIS should be contacted for advice regarding the use of antibiotics, pain killers and diagnostic techniques for use in pregnant patients. This document is regularly

2014 UK Teratology Information Service

1470. Macrolides

Macrolides USE OF MACROLIDES IN PREGNANCY 0344 892 0909 USE OF MACROLIDES IN PREGNANCY (Date of issue: June 2017 , Version: 2.1 ) This is a UKTIS monograph for use by health care professionals. For case-specific advice please contact UKTIS on 0344 892 0909. To report an exposure please download and complete a . Please encourage all women to complete an . A corresponding patient information leaflet on is available at . Summary The macrolide antibiotics include azithromycin, clarithromycin (...) , erythromycin, spiramycin and telithromycin. Macrolides have an antibacterial spectrum similar to that of penicillin and are thus considered an alternative in penicillin-allergic patients. Indications include sinusitis, otitis media, pharyngitis, tonsillitis, bronchitis, skin and soft tissue infection. Azithromycin is also used in the treatment of chlamydia, and clarithromycin in the eradication of Helicobacter pylori . The considerable data for macrolides as a class, and for erythromycin specifically, do

2014 UK Teratology Information Service

1471. Eye drops

Eye drops USE OF EYE DROPS IN PREGNANCY 0344 892 0909 USE OF EYE DROPS IN PREGNANCY (Date of issue: May 2016 , Version: 2 ) This is a UKTIS monograph for use by health care professionals. For case-specific advice please contact UKTIS on 0344 892 0909. To report an exposure please download and complete a . Please encourage all women to complete an . Summary Eye drops are used to administer medication to the eye and, depending on the condition being treated, may contain steroids, antibiotics

2014 UK Teratology Information Service

1472. Trimethoprim

Trimethoprim USE OF TRIMETHOPRIM IN PREGNANCY 0344 892 0909 USE OF TRIMETHOPRIM IN PREGNANCY (Date of issue: January 2019 , Version: 3 ) This is a UKTIS monograph for use by health care professionals. For case-specific advice please contact UKTIS on 0344 892 0909. To report an exposure please download and complete a . Please encourage all women to complete an . A corresponding patient information leaflet on is available at . Summary Trimethoprim is an antibiotic used to treat a variety (...) of bacterial infections, but most commonly in the treatment or prophylaxis of urinary tract infections. It acts as a selective inhibitor of dihydrofolate reductase to prevent folic acid synthesis, thereby inhibiting DNA replication. It is available for use as a single agent and in combination with sulfamethoxazole (co-trimoxazole), which also inhibits folate metabolism, producing a synergistic antimicrobial effect. Much of the available pregnancy exposure safety data are provided from studies which have

2014 UK Teratology Information Service

1473. Thiomersal

as an antimicrobial and preservative in biological vaccines. It is important to note that thiomersal is metabolised to ethyl mercury and thiosalicylate and not to methylmercury (a potent neurotoxin). There are few data on the effects of thiomersal or ethylmercury and thiosalicylate in human pregnancy. Data concerning the risk of congenital malformation following in utero exposure to thiomersal are limited to a single study investigating the use of thiomersal as a topical antimicrobial, not as a vaccine

2014 UK Teratology Information Service

1474. Thermal burns

, it should not be withheld on account of pregnancy. Where alternatives exist, UKTIS should be contacted for advice regarding the use of antibiotics, pain killers and diagnostic techniques for use in pregnant patients. Enhanced fetal monitoring may be recommended after maternal thermal injury. Other risk factors may also 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

2014 UK Teratology Information Service

1475. Tetracycline

Tetracycline USE OF TETRACYCLINE IN PREGNANCY 0344 892 0909 USE OF TETRACYCLINE IN PREGNANCY (Date of issue: June 2017 , Version: 1.2 ) This is a UKTIS monograph for use by health care professionals. For case-specific advice please contact UKTIS on 0344 892 0909. To report an exposure please download and complete a . Please encourage all women to complete an . A corresponding patient information leaflet on is available at . Summary The tetracyclines are a class of broad-spectrum antibiotics (...) and in the treatment of anthrax. Exposure to tetracyclines in early pregnancy has not been convincingly associated with any specific malformation, however data for some tetracyclines are extremely limited or absent. One study found a significant association with spontaneous abortion following exposure to tetracycline antibiotics. No effect of antenatal doxycycline exposure on fetal birth weight or preterm delivery risk has been identified in two studies using data from the same cohort. Rates of pregnancy outcomes

2014 UK Teratology Information Service

1476. Tacrolimus

Tacrolimus USE OF TACROLIMUS IN PREGNANCY 0344 892 0909 USE OF TACROLIMUS IN PREGNANCY (Date of issue: May 2016 , Version: 2 ) This is a UKTIS monograph for use by health care professionals. For case-specific advice please contact UKTIS on 0344 892 0909. To report an exposure please download and complete a . Please encourage all women to complete an . A corresponding patient information leaflet on is available at . Summary Tacrolimus is a potent immunosuppressive macrolide antibiotic used

2014 UK Teratology Information Service

1477. Rifampicin

Rifampicin USE OF RIFAMPICIN IN PREGNANCY 0344 892 0909 USE OF RIFAMPICIN IN PREGNANCY (Date of issue: December 2016 , Version: 2 ) This is a UKTIS monograph for use by health care professionals. For case-specific advice please contact UKTIS on 0344 892 0909. To report an exposure please download and complete a . Please encourage all women to complete an . Summary Rifampicin is a semisynthetic antibacterial drug used in the treatment of tuberculosis, leprosy, brucellosis, Legionnaire’s disease

2014 UK Teratology Information Service

1478. Pivmecillinam

is used mainly in the treatment of urinary tract infections and salmonellosis. It may also be a useful alternative antibiotic in the treatment of acute typhoid fever. Data on pivmecillinam exposure in pregnancy do not indicate that short-term use is associated with an increased risk of malformations or any other adverse fetal effects. Long-term use of pivmecillinam may be associated with carnitine deficiency, and an increase in the incidence of spontaneous abortions has been suggested but not proven

2014 UK Teratology Information Service

1479. Phenoxymethylpenicillin

Phenoxymethylpenicillin USE OF PHENOXYMETHYLPENICILLIN IN PREGNANCY 0344 892 0909 USE OF PHENOXYMETHYLPENICILLIN IN PREGNANCY (Date of issue: June 2012 , Version: 2.1 ) This is a UKTIS monograph for use by health care professionals. For case-specific advice please contact UKTIS on 0344 892 0909. To report an exposure please download and complete a . Please encourage all women to complete an . Summary Phenoxymethylpenicillin (penicillin V) is a beta-lactam antibiotic used for oral treatment

2014 UK Teratology Information Service

1480. Penicillins

), phenoxymethylpenicillin (penicillin V), amoxicillin, co-amoxiclav (amoxicillin/clavulanic acid), ampicillin, flucloxacillin, temocillin, ticarcillin, piperacillin and pivmecillinam are broad-spectrum antibacterial agents indicated in the treatment of a wide range of mild to moderately severe infections caused by susceptible micro-organisms. Penicillins may be used in pregnancy if clinically indicated. The vast majority of the large amount of available data shows no increased risk of congenital malformation

2014 UK Teratology Information Service

Evidence-based Synopses

Synopses are typically easily digested, critical commentaries of articles e.g. critically appraised topics.