Léophonte P
Service de Pneumologie et Allergologie, Hôpital Purpan, Toulouse.
Rev Mal Respir. 1988;5(3):293-8.
Respiratory infections are the second most frequent cause for antibiotic prescriptions during pregnancy, after genito-urinary infections. Overall, antibiotics are relatively innocuous. The following should be avoided: the tetracyclines, cotrimoxazole, chloramphenicol, metronidazole and the quinolones. Aminoglycosides should be administered controlling the plasma level. The beta-lactones (principally the penicillins) and the macrolides sold in France, are without any danger. Nevertheless, the rise in distribution volume and the overall physiological changes which accompany the developing pregnancy, particularly in the third trimester lead to a diminution in the serum concentration of these antibiotics and imply an adaptation, often a doubling, of the therapeutic dose administered. From the epidemiological data concerning the organisms involved in the respiratory infections, nearly the totality of extra-hospital infections may be cured by macrolides or penicillins (ampicillin). During more serious infections (nosocomial, or the immuno-depressed) the maternal prognosis should take precedence, adjusting the antibiotic to the organism, before the toxic risk to the child. All the antibiotics are excreted in the mother milk, but in very small quantities; they are generally destroyed in the digestive tract of the child so that the risk of any secondary effect during lactation is minimal.
呼吸道感染是孕期抗生素处方的第二大常见原因，仅次于泌尿生殖系统感染。总体而言，抗生素相对无害。应避免使用以下药物：四环素、复方新诺明、氯霉素、甲硝唑和喹诺酮类。氨基糖苷类药物应在控制血药浓度的情况下使用。法国销售的β-内酰胺类（主要是青霉素）和大环内酯类药物没有任何危险。然而，随着孕期进展，尤其是在孕晚期，分布容积增加以及整体生理变化导致这些抗生素的血清浓度降低，这意味着需要调整治疗剂量，通常剂量要加倍。从有关呼吸道感染所涉及病原体的流行病学数据来看，几乎所有院外感染都可用大环内酯类或青霉素（氨苄西林）治愈。在更严重的感染（医院感染或免疫低下者感染）中，应优先考虑母亲的预后，在对胎儿产生毒性风险之前，根据病原体调整抗生素。所有抗生素都会随母乳排出，但量非常少；它们通常在婴儿消化道中被破坏，因此哺乳期产生任何继发影响的风险极小。
