Centers for Disease Control and Prevention, Atlanta, Georgia; and the Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Reproductive Infectious Diseases and Obstetric Specialties, Magee-Women's Hospital of the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Obstet Gynecol. 2013 Oct;122(4):885-900. doi: 10.1097/AOG.0b013e3182a5fdfd.
To review the safety and pharmacokinetics of antimicrobials recommended for anthrax postexposure prophylaxis and treatment in pregnant women.
Articles were identified in the PubMed database from inception through December 2012 by searching the keywords (["pregnancy]" and [generic antibiotic drug name]). Additionally, we searched clinicaltrials.gov and conducted hand searches of references from REPROTOX, TERIS, review articles, and Briggs' Drugs in Pregnancy and Lactation.
Articles included in the review contain primary data related to the safety and pharmacokinetics among pregnant women of 14 antimicrobials recommended for anthrax postexposure prophylaxis and treatment (amoxicillin, ampicillin, chloramphenicol, clindamycin, ciprofloxacin, doripenem, doxycycline, levofloxacin, linezolid, meropenem, moxifloxacin, penicillin, rifampin, and vancomycin).
TABULATION, INTEGRATION, AND RESULTS: The PubMed search identified 3,850 articles for review. Reference hand searching yielded nine additional articles. In total, 112 articles met the inclusion criteria.
Overall, safety and pharmacokinetic information is limited for these antimicrobials. Although small increases in risks for certain anomalies have been observed with some antimicrobials recommended for prophylaxis and treatment of anthrax, the absolute risk of these antimicrobials appears low. Given the high morbidity and mortality associated with anthrax, antimicrobials should be dosed appropriately to ensure that antibiotic levels can be achieved and sustained. Dosing adjustments may be necessary for the β-lactam antimicrobials and the fluoroquinolones to achieve therapeutic levels in pregnant women. Data indicate that the β-lactam antimicrobials, the fluoroquinolones, and, to a lesser extent, clindamycin enter the fetal compartment, an important consideration in the treatment of anthrax, because these antimicrobials may provide additional fetal benefit in the second and third trimesters of pregnancy.
综述推荐用于炭疽暴露后预防和治疗的抗菌药物在孕妇中的安全性和药代动力学。
通过在 PubMed 数据库中搜索关键词（["妊娠"和[通用抗生素药物名称]），从创建到 2012 年 12 月，我们确定了文章。此外，我们还搜索了 clinicaltrials.gov，并对 REPROTOX、TERIS、综述文章以及 Briggs' Drugs in Pregnancy and Lactation 中的参考文献进行了手工搜索。
综述中包含的文章包含与推荐用于炭疽暴露后预防和治疗的 14 种抗菌药物（阿莫西林、氨苄西林、氯霉素、克林霉素、环丙沙星、多利培南、强力霉素、左氧氟沙星、利奈唑胺、美罗培南、莫西沙星、青霉素、利福平、万古霉素）在孕妇中的安全性和药代动力学相关的原始数据。
列表、整合和结果：PubMed 搜索确定了 3850 篇文章进行综述。参考文献手工搜索又提供了 9 篇文章。总共，有 112 篇文章符合纳入标准。
总体而言，这些抗菌药物的安全性和药代动力学信息有限。虽然某些推荐用于预防和治疗炭疽的抗菌药物观察到某些畸形的风险略有增加，但这些抗菌药物的绝对风险似乎较低。鉴于炭疽的高发病率和死亡率，应适当给予抗菌药物剂量，以确保可以达到和维持抗生素水平。为了在孕妇中达到治疗水平，可能需要调整β-内酰胺类抗菌药物和氟喹诺酮类药物的剂量。数据表明，β-内酰胺类抗菌药物、氟喹诺酮类药物，在较小程度上还有克林霉素，进入胎儿隔室，这是治疗炭疽的一个重要考虑因素，因为这些抗菌药物可能在妊娠的第二和第三阶段为胎儿提供额外的益处。
