Each future mother, together with the news of her situation, realizes that she will have to reconsider her way of life in the next few months. Exclusively towards its usefulness. But there are very twofold situations. That’s what to do if you get sick? It is clear that this should be avoided, but if it does happen. To the choice of medication a pregnant woman should be treated with all responsibility and in no case do self-medication.
Drug drug is different, but, probably, everyone knows that antibiotics in pregnancy are evil. But is it absolute?
Briefly about antibiotics
In a few words, we will consider the use and harm of antibiotics on any organism. After all, we all know that it’s not worth it just to go into their use. This is a very aggressive category of pharmaceuticals. And yet very diverse. In any case, antibiotics require a special order of administration – as prescribed by a physician and in accordance with a strict course. In other words, antibiotics can not only be useless, but also cause harm if you have prescribed them at your own discretion. And that’s why.
The main action of any antibiotics is the destruction of bacteria. Only bacteria, and therefore, against viruses and fungi, they are useless. Can a simple man in the street “understand” by reason of what he coughs or snot – due to a virus or because of a bacterium? Hardly. And half the trouble, if the medicine simply would not have acted on the causative agent of the disease, but it can in fact affect other aspects of the life of the organism!
Most (but not all!) Antibiotics are very toxic, yet some of their effects are not so radical and only a few are practically harmless. Among the side effects of antibiotics – the load on the liver, the destruction of useful microflora (for example, in the intestine or vagina), dysbiosis and digestive disorders, the development of fungal diseases (candidiasis). Some of them (in particular from the gentamicin group) affect the functioning of the kidneys and the inner ear at all.
Another feature of antibiotics is that to destroy a particular bacterium, you may need a complex of several drugs or a course of a certain duration. Inconsistency, and develops resistance! This mysterious word means that the bacterium remains in the body, its activity may have died down, but next time (with exacerbation or relapse) the group of medicines used for the first time will be useless. Such an immunity to the substance is produced by the bacteria.
The imperfection of antibiotics consists in the fact that most of them do not know much about which bacteria act. But in the human body lives and a useful microflora. And very often it is more sensitive to antibiotics, that is, it dies before pathogens. The use of antibiotics for the body is almost always stressful. Here we need to weigh the pros and cons: whether antibiotics can be dispensed with, and well, if so. If antibiotics are simply necessary (and it is determined solely by a specialized physician), then an attentive doctor will certainly prescribe to his patient a course of hepatoprotectors and probiotics. Going to antibiotics from time to time – normally, but regularly – is harmful. If a person becomes a victim of bacterial infections again and again, the doctor should think about changing the treatment strategy and, more likely, restoring immunity. Frequent use of antibiotics only undermines it.
Why can not antibiotics in pregnancy?
So, antibiotics are not harmless pills. They will not be appointed without any cause to anyone, let alone a future mother. The statement that antibiotics during pregnancy under strict prohibition is more likely an exaggeration. In some cases, one can not do without them. But it is determined by the doctor again.
What is the danger of antibiotics in pregnancy? First, all the above listed negative actions remain – a blow to the liver and kidneys (and during the pregnancy the load on them is already increased), the dysbacteriosis of not only the intestines, but also the genital tracts, the weakening of the immunity of the future mother (after all this alone is not enough). Secondly, it is especially undesirable to use antibiotics in the first trimester of pregnancy, when the fetus is just being formed. The next two terms have their contraindications.
- Antibiotics during pregnancy in the first trimester are dangerous then, around the embryo is not yet formed a reliable placental barrier. The impact of antibiotics and other harmful substances will be the strongest. At this stage, the foundation for the formation of tissues and systems of the future little man is laid. In the first three months there are practically no antibiotics allowed for use, but in each individual case the medic is guided by the rule “the expected benefit for the mother must exceed the potential risks for her and the fetus.”
- Antibiotics during pregnancy in the second trimester can be appointed. But not from the category of those that can affect the development of the brain and the reproductive system of the fetus.
- The appointment of antibiotics during pregnancy in the third trimester differs little from the overall strategy. Of course, the benefits to the mother and the likelihood of pathologies and anomalies in the fetus are still taken into account. However, the fetus is protected in this period reliably, many toxic substances to it the placenta does not miss, however, not all.
Particular attention should be paid to the situation when in the first days or weeks of pregnancy, not being aware of their situation, a woman takes antibiotics. And sometimes completely unacceptable in this period. What to do in fact? General advice – ask for a consultation with a professional who will specifically consider your case (what was being treated, how they treated, how successfully, how long and during pregnancy). Advice in particular – make ultrasound and blood tests, the doctor will analyze whether the dynamics of development of pregnancy is not violated. Do not expect the worst, but no one will insist on aborting a pregnancy without a good reason. At the same time, it should be noted that the course of a disease in the first days of pregnancy and the use of antibiotics in treatment can “haggle” at a later date, from this no one is immune.
The opinion about the admissibility of an antibiotic in pregnancy is made on the basis of the conducted studies:
- if their toxic effects are proven, the preparations are expressly banned;
- if the action of the drug is not sufficiently studied and against this background their negative is not singled out, then they can be appointed, but in extreme cases;
- if the research proves the absence of side effects on the pregnant and fetus, the antibiotic is allowed to use if necessary and the lack of alternative methods of treatment.
Antibiotics during pregnancy, as well as in general, are not recommended to be prescribed without a special test for the sensitivity of bacteria to them. If this is not possible or does not show an unambiguous result, then preparations of a wide spectrum of action are prescribed. This decision lies in the competence of a specialized specialist. It is necessary to inform him about the position of the woman, the timing and other features of the course of pregnancy.
What antibiotics are allowed in pregnancy?
We came to the conclusion that antibiotics in pregnancy in some cases to appoint it is necessary. We’ll figure out now what and when:
– absolute contraindications (it is impossible in any case):
- tetracycline and doxycycline – easily penetrate the placenta, what can we say about the first months; accumulate in the bones and dentition of the fetus, disrupt the processes of mineralization, poisonous to the liver;
- fluoroquinolones (ciprofloxacin, ciprolet, nolycin, abaktal, floxal, etc.) – are prohibited because there are still no reliable grounds to assert their safety (there is no evidence base), while the ability of substances to damage joints of the fetus is established;
- clarithromycin (klatsid, fromilid, klabaks) and midekamycin, roxithromycin (macropen, rulid) – safety of use in pregnancy is also not known, there are data on toxic effects on the fetus in animals;
- aminoglycosides (kanamycin, tobramycin, streptomycin) – also have a high ability to penetrate the placenta; provoke the risk of complications on the kidney and inner ear of the fetus, can cause deafness in the newborn;
- gentamicin – in its properties is identical to aminoglycosides, but can be prescribed (better, of course, at later dates) for vital indications and in strictly calculated dosages;
- furazidine (furamag, furagin) and nifuroxazide (erfefuril, enterofuril) – their effect is assessed as potentially dangerous due to the lack of data on the effects on pregnancy;
- chloramphenicol (levomycetin, sintomycin, olazol) – is prohibited, because it passes very quickly through the placenta, and even in high concentrations; negatively affects the development of the brain and disrupts the division of blood cells; It is dangerous, among other things, and in late pregnancy;
- dioxydin – has become banned for pregnant women after its toxic and mutagenic effect has been proven in animal experiments;
- co-trimoxazole (biseptol, bactrim, groseptol) – again differs permeability through the placenta and in high concentrations; its constituent trimethoprim is an active antagonist of folic acid; co-trimoxazole increases the risk of congenital malformations, heart defects, and also slows the growth of the fetus;
– relative contraindications (appointed in case of emergency):
- azithromycin (sumamed, zitrolid, zi-factor, chemomycin) – is prescribed exclusively in case of emergency, in particular without it, chlamydial infection in pregnant women; negative impact on the fetus is not revealed, especially in comparison with developing chlamydia;
- nitrofurantoin (furadonin) – permissible for use only in the second trimester, is prohibited in both the first and third trimesters;
- metronidazole (clion, trichopolum, metrogil, flagel) – is definitely prohibited in the first trimester; In the second and third, appointments can only be made if there is no safer alternative; marked risk of developing defects in the brain, limbs and genitals in the fetus;
- gentamycin – use is allowed only for vital indications and in strictly calculated dosages; the excess of doses is dangerous for the development of deafness and kidney pathologies in a newborn;
– are allowed (you can, but again, if necessary):
- penicillin and its analogues (amoxicillin, amoxiclav, ampicillin) – although they penetrate the placenta, but do not have harmful effects on the fetus, and are also rapidly excreted by the kidneys;
- cephalosporins (cefazolin, cefalexin, ceftriaxone, cefuroxime, cefixime, cefoperazone, cefotaxime, ceftazidime, cefepime) – are used in pregnancy without restrictions, because through the placenta pass in extremely low concentrations and numerous studies have not shown a negative impact on the fetus of substances penetrated to it;
- erythromycin, josamycin (vilprafen) and spiramycin (rovamycin) – are acceptable for use because they do not cause any anomalies, and through the placenta itself they penetrate in the smallest amounts.
After passing the doctor’s prescribed course of the above listed permitted preparations, a second appointment is necessary – to assess the woman’s well-being and repeated examinations.
Indications for taking antibiotics in pregnancy
In general, it can be said that the indications for prescribing antibiotics during pregnancy are not much different from the general ones. A competent physician will never simply prescribe an antibiotic if one can do without it. The same applies to prescribing for a pregnant woman. Just a window of opportunity already and have to manage only allowed to use medicines. In combination with antibiotics, a pregnant woman should be prescribed funds for the prevention of dysbacteriosis, complications of the kidney and liver and, of course, immunomodulating measures.
The most popular group of antibiotics, prescribed during pregnancy, are penicillins. Ampicillin, amoxicillin, amoxiclav, oxamp – in fact they can essentially help the patient. They are applied in the form of injections and orally. This solution for diseases such as sinusitis, bronchitis, pneumonia, pyelonephritis, lymphadenitis.
Antibiotics from the group of cephalosporins should be administered with greater caution. Ceftriaxone in pregnancy is a strong antibiotic, effective even against the most resistant microorganisms. Therefore, it is likely to be prescribed for infections of the genitourinary system, respiratory and digestive tracts, skin.
With urogenital bacterial diseases, vilprafen is relevant. Including ureaplasmosis. Ignoring this problem during pregnancy is dangerous for both the woman and the fetus.
Cefazolin is prescribed under extremely strict indications, and then from the second trimester. They usually manage to cure pneumonia, osteomyelitis, infections of the joints and bone system, skin, urinary system.