From the Guidelines
For pregnant women with pneumonia, the safest antibiotics are typically penicillins, cephalosporins, and macrolides, with azithromycin being a recommended option 1. When considering the treatment of pneumonia in pregnant women, it is essential to prioritize the safety of both the mother and the fetus. The choice of antibiotic should be based on the severity of the infection, local resistance patterns, and individual patient factors.
- Penicillins and cephalosporins are classified as Category B drugs by the FDA, meaning animal studies have not demonstrated fetal risk.
- Macrolides, such as azithromycin, have a long history of safe use in pregnancy, although they are classified as Category C 1.
- A study published in the European Respiratory Journal in 2020 suggests that erythromycin and metronidazole may also be safe options, but with certain precautions and considerations 1. The recommended treatment regimens include:
- Amoxicillin 500 mg orally three times daily for 5-7 days
- Cefuroxime 500 mg orally twice daily for 5-7 days
- Azithromycin 500 mg orally once daily for 3 days It is crucial to treat pneumonia promptly in pregnant women to prevent complications for both mother and fetus, while using medications with established safety profiles in pregnancy 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 efficacy and safety of amoxicillin-clavulanic acid for the treatment of bacterial community-acquired pneumonia in adults has been demonstrated in a study, which showed significant improvement in clinical and laboratory parameters 4.
- CURB65-guided antibiotic therapy has been shown to reduce broad-spectrum antibiotic prescribing without compromising patient safety, and amoxicillin is recommended as a narrower-spectrum agent for low-risk patients 5.
- A cost-effectiveness analysis of antibiotic therapy in macrolide-resistant community-acquired pneumonia found that amoxicillin/clavulanate extended-release resulted in a higher percentage of patients cured and lower average per-patient treatment costs compared to clarithromycin ER 6.
- While there is limited data on antibiotic prescribing patterns for pregnant women with community-acquired pneumonia, amoxicillin/clavulanate is commonly used in children and adults, and its safety profile is well established 3, 4, 7.
Key Findings
- Amoxicillin/clavulanate is a safe and effective antibiotic for treating community-acquired pneumonia in adults 3, 4.
- CURB65-guided antibiotic therapy can help reduce broad-spectrum antibiotic prescribing without compromising patient safety 5.
- Amoxicillin/clavulanate extended-release is a cost-effective option for treating macrolide-resistant community-acquired pneumonia 6.
- Further research is needed to evaluate the safety and efficacy of antibiotics in pregnant women with community-acquired pneumonia.