Antimicrobials and pregnancy

The physiologic changes that occur during pregnancy result in pharmacokinetic changes that can alter the effectiveness of antimicrobial agents. The possible risk of teratogenic and toxic effects of antimicrobials on the fetus is an additional cause of concern. In general, pregnant women are excluded from clinical trials and there is little pharmacokinetic information on the use and proper dosing of antimicrobials in this population. Although most antimicrobials can cross the placental blood barrier, data on the potential teratogenic effects, and fetal and neonatal toxicity caused by antimicrobials are also limited and of varying reliability. This article reviews the available evidence with the greatest clinical relevance regarding the pharmacology of different antibiotic, antifungal, antiviral, and antiparasitic agents in pregnancy, with particular focus on data related to fetal toxicity. (C) 2009 Elsevier Espana, S.L. All rights reserved.