From the Guidelines
For pregnant women with pneumonia, the safest antibiotic options are azithromycin and amoxicillin, as they have a long history of safe use and pose minimal risk to fetal development. When considering the treatment of pneumonia in pregnant women, it is crucial to prioritize the safety of both the mother and the fetus.
- Azithromycin is a preferred option for atypical pneumonia, with a recommended dose of 500 mg orally once daily for 3 days 1.
- Amoxicillin is often the first choice for mild cases, with a recommended dose of 500 mg orally three times daily for 5-7 days 1. The choice of antibiotic depends on the severity of pneumonia, suspected pathogens, and individual patient factors, such as the stage of pregnancy and the presence of any underlying medical conditions 1. It is essential to note that doxycycline, although considered possibly safe, should be avoided during the second and third trimesters and at delivery due to the risk of tooth discoloration and transient suppression of bone growth in the fetus 1. Close monitoring of the pregnant woman and fetus is essential during treatment, and the treatment duration may be extended based on clinical response. In general, the use of antibiotics during pregnancy should be guided by the principles of minimizing risk to the fetus while effectively treating the maternal infection, and azithromycin and amoxicillin are considered the safest options based on the available evidence 1.
From the FDA Drug Label
Pregnancy Category B Reproduction studies have been performed in rats and mice at doses up to moderately maternally toxic dose concentrations (i.e., 200 mg/kg/day). These doses, based on a mg/m2 basis, are estimated to be 4 and 2 times, respectively, the human daily dose of 500 mg. In the animal studies, no evidence of harm to the fetus due to azithromycin was found. There are, however, no adequate and well-controlled studies in pregnant women Because animal reproduction studies are not always predictive of human response, azithromycin should be used during pregnancy only if clearly needed. Community-acquired pneumonia due to Chlamydophila pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae or Streptococcus pneumoniae in patients appropriate for oral therapy
Safe antibiotics for pneumonia in pregnant women include:
- Azithromycin, but only if clearly needed and for mild to moderate infections.
Note: The FDA label does not provide a comprehensive list of safe antibiotics for pneumonia in pregnant women, and the use of any antibiotic during pregnancy should be carefully considered and monitored by a healthcare provider 2.
From the Research
Safe Antibiotics for Pneumonia in Pregnant Women
- Amoxicillin/clavulanate is a broad-spectrum antibacterial that has been used for over 20 years to treat community-acquired respiratory tract infections, including pneumonia 3.
- The safety and tolerance profile of amoxicillin/clavulanate is well known, and it is included in guidelines and recommendations for the treatment of bacterial sinusitis, acute otitis media, community-acquired pneumonia, and acute exacerbations of chronic bronchitis 3.
- Amoxicillin has better pharmacodynamic/pharmacokinetic properties relative to penicillin, making it a reasonable option for the treatment of community-acquired pneumonia (CAP) 4.
- High-dose parenteral penicillin G and parenteral/oral amoxicillin may be initial choices for the empiric treatment of uncomplicated pneumococcal pneumonia in certain regions 4.
- Other options for the treatment of pneumococcal pneumonia include parenteral cefuroxime, ceftriaxone, cefotaxime, newer quinolones, macrolides, and telithromycin 4.
Considerations for Pregnant Women
- Pregnant women with moderate symptoms of COVID-19 pneumonia may be treated with remdesivir, antibiotics, and/or glucocorticoids, but the safety and efficacy of these treatments are still being studied 5.
- The use of antibiotics in pregnant women with pneumonia should be guided by local and national resistance data, as well as international guidelines 6.
- The management of pregnant women with COVID-19 pneumonia requires a multidisciplinary approach, and the timing of delivery and delivery mode should be individualized 7.