تجویز آنتی بیوتیک در حاملگی و شیردهی

نوع مقاله: مروری

نویسندگان

1 دانشیار بیماریهای عفونی و گرمسیری، دانشکده پزشکی، دانشگاه علوم پزشکی شهید صدوقی یزد

2 - استادیار ژنتیک، دانشکده پزشکی، دانشگاه علوم پزشکی شهید صدوقی یزد

3 استادیار آسیب شناسی، دانشکده پزشکی، دانشگاه علوم پزشکی شهید صدوقی یزد

4 استادیار خون اطفال، دانشکده پزشکی، دانشگاه علوم پزشکی شهید صدوقی یزد

5 دانشیار قلب اطفال، دانشکده پزشکی، دانشگاه علوم پزشکی شهید صدوقی یزد

چکیده

مقدمه: در هر لحظه میلیون ها نفر زن در وضعیت حاملگی یا شیردهی می باشند که تعدادی از آنها به علت ابتلا به
عفونت لازم است که تحت درمان با آنتی بیوتیک های مختلف قرار گیرند. این آنتی بیوتیک ها علاوه بر عوارضی که
برای مادر دارند می توانند برای جنین و نوزاد نیز مشکلاتی ایجاد کنند. در این مقاله در مورد ده آنتی بیوتیک که
می توانند عوارض شدید ایجاد کنند بحث خواهد شد.
روش کار : با استفاده از کلمات کلیدی teratogenic ، teratogen ،breast-feeding ، lactation ، pregnancy ،antibiotic
و نام ده آنتی بیوتیک آموکسی سیلین، پنی سیلینG، پنی سیلینV، کلیندامایسین، سیپروفلوکساسین، داکسی سیلین،
کلرامفنیکل، ریفامپین، جنتامیسین و وانکومیسین مقالات قابل دسترسی در مدلاین به زبان انگلیسی مورد مطالعه قرار گرفتند.
همچنین از مقالات فارسی موجود در پایگاه اطلاعات علمی جهاد دانشگاهی (SID) نیز استفاده شد.
نتایج: در مجموع 101 مقاله که در رابطه با آنتی بیوتیک، حاملگی و شیردهی،تراتوژن وتراتوژنیک بودند، مورد مطالعه قرار
گرفتند. پنی سیلین G وV غیر تراتوژن و آموکسی سیلین، سیپروفلوکساسین، داکسی سیکلین، کلرامفنیکل وریفامپین جزو
غیر محتمل ها از نظر تراتوژن بودن تقسیم بندی شده اند. جنتامایسین، کلیندامایسین و وانکومایسین جزو آنتی بیوتیک هایی
هستند که تراتوژن بودن آنها نامشخص است. در ضمن حاملگی تغییرات مشخصی در رابطه با جنتامایسین، پنی سیلین ها و
فلوروکینولون ها اتفاق می افتد. کلیه آنتی بیوتیک های فوق از شیر عبور می کنند، ولی مقادیر آن ها در شیر (به استثنای
کلرامفنیکل) به اندازه ای نیست که برای شیر خوار مشکلی ایجاد کند.
نتیجه گیری: آنتی بیوتیک ها مانند سایر داروها علاوه بر فواید زیادی که دارند دارای عوارضی نیز می باشند که
در طی حاملگی و شیردهی، هنگام تجویز آنها، علاوه بر در نظر گرفتن فواید و عوارض آن برای مادر باید اثر آن را
بر جنین وشیرخوار نیز در نظر گرفت. با در نظر گرفتن این نکته که پس از سال ها هنوز مقالات جدیدی در مورد
عوارض این آنتی بیوتیک ها نوشته شده وبه صورت گزارش مورد نیز چاپ می گردد، لازم است همکاران نیز هرچه
بیشتر با این عوارض آشنا ودر صورت مواجه با عوارض جدید آن ها را گزارش کنند

کلیدواژه‌ها


عنوان مقاله [English]

Use of Antibiotic in Pregnancy and Lactation

نویسندگان [English]

  • Jamshid Ayatollahi 1
  • Nasrin Ghasemi 2
  • Shokouh Taghipour Zahir 3
  • Azamosadat Hashemi 4
  • Mostafa Behjati 5
1 Associate Professor of Infectious Diseases and Tropical, Faculty of Medicine, Shahid Sadoghi Yazd University of Medical Sciences, Yazd, Iran
2 Assistant Professor of Genetic, Faculty of Medicine, Shahid Sadoghi Yazd University of Medical Sciences, Yazd, Iran
3 Assistant Professor of Pathology, Faculty of Medicine,, Shahid Sadoghi Yazd University of Medical Sciences, Yazd, Iran
4 Assistant Professor of Pediatric Hematology & Oncology, Faculty of Medicine,, Shahid Sadoghi Yazd University of Medical Sciences, Yazd, Iran
5 Assistant Professor of Pediatric Cardiology, Faculty of Medicine,, Shahid Sadoghi Yazd University of Medical Sciences, Yazd, Iran
چکیده [English]

Introduction: At any time many women are pregnant or lactating worldwide. The medication use by these women is accompanied by significant risks. In addition to normal physiologic changes that alter the pharmacokinetics of drugs, there is concern for the possible teratogenicity and toxic effects of the drugs on the developing fetus and newborn. This article reviews the risks and pharmacokinetic considerations for 10 broad-spectrum antibiotics that can be used to treat various infections during pregnancy and lactation.
 
Methods: Information from the Pub Med was reviewed concerning the use of 10 antibiotics (amoxicillin, penicillin G and V, doxycycline, chloramphenicol, ciprofloxacin, rifampin, clindamycin, gentamicin, vancomycin) in pregnant and lactating women.
 
The PubMed search engine was used with the search terms [antibiotic name] and teratogen or tratogenic “[antibiotic name] and pregnancy,” “[antibiotic name] and lactation,” and “[antibiotic name] and breast-feeding” from 1966 to November 2007. Standard reference tracing was done as well. The Scientific Information Database was searched with the similar keywords for Persian articles.
 
Results: One hundred and one references had sufficient information regarding the number of subjects, and the methods. So their findings were included in the study.
 
The teratogenic potential of the drugs in humans ranged from “none” for penicillin G and penicillin V to “unlikely” for amoxicillin, chloramphenicol, ciprofloxacin, doxycycline, and rifampin and to “undetermined” for clindamycin, gentamicin, and vancomycin. Significant pharmacokinetic changes occur during pregnancy for penicillins, fluoroquinolones, and gentamicin, which indicate that dosage of these drugs should be adjusted in the pregnancy period. All of these antibiotics but chloramphenicol can be prescribed during breast-feeding period.
 
Conclusion: Having considered the possible teratogenicity and side effects of these drugs, penicillin and amoxicillin can be prescribed safely but tetracycline should be avoided during pregnancy and lactation.

کلیدواژه‌ها [English]

  • Antibiotic
  • pregnancy
  • Lactation
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