USE OF CEPHALOSPORINS IN PREGNANCY

View printable version
(Date of issue: June 2017, Version: 3.1)

This is a UKTIS monograph for use by health care professionals. For case-specific advice please contact UKTIS on 0344 892 0909. To report an exposure please download and complete a pregnancy reporting form. Please encourage all women to complete an online reporting form.

A corresponding patient information leaflet on cephalosporin use in pregnancy is available at www.medicinesinpregnancy.org.

Summary

The cephalosporins (commonly used include: cefaclor, cefadroxil, cefalexin, cefixime, cefotaxime, cefpodoxime, cefradine, ceftazidime, ceftriaxone and cefuroxime) are a class of β-lactam antibiotics originally derived from the Acremonium fungus. Cephalosporins are broad-spectrum antibacterial agents used in the treatment of respiratory tract infections, otitis media, skin and soft tissue infections, urinary tract infections, sexually transmitted infections, septicaemia, meningitis, peritonitis, endocarditis, and in the prophylaxis of postoperative infections.

The majority of the available data on the use of cephalosporins in pregnancy do not suggest that therapeutic doses of these drugs are associated with an increased risk of spontaneous abortion or congenital abnormalities. However, two studies have identified a possible association between in utero cephalosporin exposure and cardiovascular defects in exposed offspring, with single studies also suggesting an increased risk of oral clefts and anorectal atresia. A causal link between cephalosporin use in pregnancy and any congenital malformation remains to be proven.

Only one study for cefuroxime specifically has assessed risk of preterm delivery, low birth weight, neonatal complications and neurodevelopmental impairment, but included pregnancies exposed to another cephalosporin in the comparison cohort. Interpretation of the study findings as regards fetal risk is thus limited. 

Where possible, the results of culture and sensitivity tests should be available before making a treatment choice in accordance with local prescribing guidelines. However, if clinically indicated, cephalosporins may be used at any stage during pregnancy. 

Exposure to cephalosporins at any stage of pregnancy would not usually be regarded as medical grounds for termination of pregnancy or any additional fetal monitoring. However, other risk factors may be present in individual cases which may independently increase the risk of adverse pregnancy outcome. Clinicians are reminded of the importance of consideration of such factors when performing case-specific risk assessments.

This document is regularly reviewed and updated. Only use full UKTIS monographs downloaded directly from TOXBASE.org to be sure you are using the most up-to-date version. The summaries of these monographs are openly available on UKTIS.org.

This is a summary of the full UKTIS monograph for health care professionals and should not be used in isolation. The full UKTIS monograph and access to any hyperlinked related documents is available to health care professionals at www.toxbase.org.

If you have a patient with exposure to a drug or chemical and require assistance in making a patient-specific risk assessment, please telephone UKTIS on 0344 892 0909 to discuss the case with a teratology specialist.

If you would like to report a pregnancy to UKTIS please click here to download our pregnancy reporting form. Please encourage all women to complete an online reporting form.

Disclaimer: Every effort has been made to ensure that this monograph was accurate and up-to-date at the time of writing, however it cannot cover every eventuality and the information providers cannot be held responsible for any adverse outcomes of the measures recommended. The final decision regarding which treatment is used for an individual patient remains the clinical responsibility of the prescriber. This material may be freely reproduced for education and not for profit purposes within the UK National Health Service, however no linking to this website or reproduction by or for commercial organisations is permitted without the express written permission of this service. This document is regularly reviewed and updated. Only use UKTIS monographs downloaded directly from TOXBASE.org or UKTIS.org to ensure you are using the most up-to-date version.