Korzeniowski O M
Medical College of Pennsylvania, Philadelphia, USA.
Infect Dis Clin North Am. 1995 Sep;9(3):639-51.
Except for topical, nonabsorbable agents, any antibiotic chosen for use in pregnancy exposes the fetus as well as the mother to its effects. Therefore, initiation of antimicrobial therapy must be based on clear-cut necessity. Because the physiology of the maternal-fetal unit is complex and ethical consideration of potential fetal harm is pre-eminent, data on safety are derived from animal studies, incidental observations on individual women treated with an agent, or longitudinal tracing of groups of women who required treatment with a particular antimicrobial regimen. Consequently, a rating of absolute safety in pregnancy has never been assigned to any currently available antimicrobial agent. Decades of clinical experience with penicillins, cephalosporins, and erythromycins have documented the pharmacokinetics of these drugs in pregnant women as well as their overall safety for the fetus. These classes of drugs are those most favored for use in pregnancy for susceptible infections. Although aminoglycosides have known toxic effects on the fetus, they are safe to use if serum levels are carefully monitored in the mother. Agents in the quinolone, sulfonamide, and tetracycline categories should be avoided unless maternal necessity for their use justifies the exposure of the fetus to their toxicity. Both clinical and experimental data are very limited on the newer agents, such as the new macrolides, azithromycin and clarithromycin. The first-line agents for the treatment of TB (i.e., INH, rifampin, and ethambutol) are considered safe in pregnancy, but in the era of multidrug-resistant mycobacterial isolates, agents with known or suspected fetal toxicity may need to be used.
除局部使用的、不可吸收的药物外，孕期选用的任何抗生素都会使胎儿和母亲都受到其影响。因此，抗菌治疗的启动必须基于明确的必要性。由于母胎单位的生理情况复杂，且对潜在胎儿危害的伦理考量至关重要，关于安全性的数据来源于动物研究、对接受某种药物治疗的个别女性的偶然观察，或对需要特定抗菌治疗方案的女性群体的长期追踪。因此，目前尚无任何可用的抗菌药物被评定为在孕期绝对安全。数十年来，青霉素类、头孢菌素类和红霉素类药物的临床经验已证明了这些药物在孕妇体内的药代动力学及其对胎儿的总体安全性。这些药物类别是孕期治疗易感感染最常用的药物。尽管氨基糖苷类药物已知对胎儿有毒性作用，但如果对母亲的血清水平进行仔细监测，则使用是安全的。喹诺酮类、磺胺类和四环素类药物应避免使用，除非母亲使用这些药物的必要性证明让胎儿暴露于其毒性是合理的。关于新的药物，如新型大环内酯类药物阿奇霉素和克拉霉素，临床和实验数据都非常有限。治疗结核病的一线药物（即异烟肼、利福平、乙胺丁醇）在孕期被认为是安全的，但在耐多药分枝杆菌分离株出现的时代，可能需要使用已知或疑似对胎儿有毒性的药物。
