What are the effects of Clindamycin (Clindamycin) on pregnancy?

From the Guidelines

Klindamisin dapat digunakan selama kehamilan jika diperlukan, karena umumnya dianggap aman untuk wanita hamil. Berikut adalah beberapa poin penting yang perlu dipertimbangkan:

• Klindamisin diklasifikasikan sebagai kategori B kehamilan FDA, yang berarti studi hewan tidak menunjukkan risiko pada janin, dan tidak ada studi yang cukup pada wanita hamil yang menunjukkan efek sampingan 1.
• Dosis oral yang umum untuk infeksi selama kehamilan adalah 300-450 mg setiap 6-8 jam, sedangkan formulasi topikal dapat digunakan sesuai dengan petunjuk untuk kondisi kulit 1.
• Klindamisin sering dipilih daripada beberapa antibiotik lain selama kehamilan karena dapat menembus plasenta untuk mengobati infeksi yang mungkin mempengaruhi janin 1.
• Namun, seperti semua obat selama kehamilan, klindamisin hanya boleh digunakan jika manfaat potensial melebihi risiko 1.
• Efek sampingan dapat termasuk gangguan gastrointestinal seperti diare, mual, atau muntah 1.
• Diare parah harus segera dilaporkan kepada penyedia layanan kesehatan karena dapat menunjukkan kondisi serius yang disebabkan oleh infeksi Clostridioides difficile 1.
• Selalu konsultasikan dengan penyedia layanan kesehatan sebelum mengambil obat apa pun selama kehamilan 1.

From the FDA Drug Label

Pregnancy: Teratogenic effects In clinical trials with pregnant women, the systemic administration of clindamycin during the second and third trimesters, has not been associated with an increased frequency of congenital abnormalities Clindamycin should be used during the first trimester of pregnancy only if clearly needed. There are no adequate and well-controlled studies in pregnant women during the first trimester of pregnancy. Because animal reproduction studies are not always predictive of the human response, this drug should be used during pregnancy only if clearly needed Reproduction studies performed in rats and mice using oral doses of clindamycin up to 600 mg/kg/day (3.2 and 1.6 times the highest recommended adult human dose based on mg/m2, respectively) or subcutaneous doses of clindamycin up to 250 mg/kg/day (1.3 and 0. 7 times the highest recommended adult human dose based on mg/m2, respectively) revealed no evidence of teratogenicity.

Klindamisin use in pregnancy should be done with caution.

• It is not associated with an increased frequency of congenital abnormalities when used in the second and third trimesters.
• However, there are no adequate and well-controlled studies in pregnant women during the first trimester of pregnancy.
• The drug should be used during pregnancy only if clearly needed 2.

From the Research

Clindamycin Use in Pregnancy

• Clindamycin is used as an alternative antibiotic prophylaxis in patients with penicillin or cephalosporin allergy labels 3
• The use of clindamycin was associated with higher incidences of surgical site infections (SSIs) in previous reports 3
• Clindamycin exposure during pregnancy was associated with an increased risk of major congenital malformations (MCMs), musculoskeletal system malformations, and ventricular/atrial septal defect 4

Safety of Clindamycin in Pregnancy

• Clindamycin is considered a viable option for treatment of infections caused by certain bacteria during pregnancy 5
• However, the safety profile of clindamycin during pregnancy is not well established, and its use should be carefully considered 6
• Clindamycin was associated with adverse pregnancy outcomes, including MCMs, in a population-based cohort study 4

Alternative Antibiotics in Pregnancy

• Penicillin and ampicillin are valuable antibiotics in obstetrics due to their excellent activity against group A and group B streptococci 5
• Cephalosporins, such as ceftriaxone, are also effective against certain bacterial infections during pregnancy 5
• Erythromycin and azithromycin have value primarily for treatment of endocervical chlamydial infections and mycoplasma pneumonia in obstetric patients 5

Penicillin Allergy and Clindamycin Use

• Penicillin allergy evaluation in pregnant patients can help reduce the use of broad-spectrum antibiotics, such as clindamycin, and increase the use of first-line beta-lactam antibiotics 7
• Clindamycin was largely administered in patients with non-severe hypersensitivity reactions, low-risk history, or unknown reactions to penicillin or cephalosporin 3