Is Clindamycin (antibiotic) safe during pregnancy?

From the Guidelines

Clindamycin should be used with caution during pregnancy, particularly when considering the potential risks and benefits, as evidence suggests an increase in adverse events with the use of clindamycin cream, especially in newborns 1. When evaluating the safety of clindamycin during pregnancy, it's essential to consider the potential benefits and risks. According to the 2002 guidelines from the Centers for Disease Control and Prevention, clindamycin cream has been associated with an increase in adverse events, such as prematurity and neonatal infections, in newborns 1.

Key Considerations

• The use of clindamycin during pregnancy should be carefully evaluated, taking into account the potential risks and benefits.
• Clindamycin is classified as a pregnancy category B medication, meaning animal studies have not shown risk to the fetus, and there are no adequate studies in pregnant women showing adverse effects.
• The typical oral dosage ranges from 300-450 mg every 6-8 hours, depending on the infection being treated.
• Common side effects include gastrointestinal disturbances such as diarrhea, nausea, and vomiting.

Important Evidence

• A study from 2002 suggests that the use of clindamycin cream during pregnancy may be associated with an increase in adverse events, particularly in newborns 1.
• In contrast, metronidazole has not been shown to have teratogenic or mutagenic effects in newborns, according to multiple studies and meta-analyses 1.

Clinical Implications

• Clindamycin can be prescribed during any trimester of pregnancy when the potential benefits outweigh the risks.
• However, it's crucial to use clindamycin under healthcare provider supervision, who can evaluate the specific situation and determine if clindamycin is appropriate for the condition.
• The healthcare provider should carefully weigh the potential benefits and risks of using clindamycin during pregnancy, considering the latest evidence and guidelines.

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

• Clindamycin use during pregnancy should be approached with caution.
• The drug may be used during the second and third trimesters without increased risk of congenital abnormalities.
• However, during the first trimester, it should only be used if clearly needed, as there are no adequate and well-controlled studies in pregnant women during this period.
• Animal reproduction studies have shown no evidence of teratogenicity, but these may not always predict the human response 2 3.

From the Research

Safety of Clindamycin During Pregnancy

• Clindamycin is generally considered safe and effective in pregnancy, along with other antibiotics such as beta-lactams, vancomycin, nitrofurantoin, metronidazole, and fosfomycin 4.
• Physiologic changes in pregnancy may lead to pharmacokinetic alterations in antibiotics, requiring dose adjustment or careful monitoring and assessment 4.
• Vaginal suppositories containing clindamycin have shown curative effects in nonpregnant women with aerobic vaginitis, and may be a better choice for pregnant women with this condition than metronidazole 5.
• A randomized controlled trial found that clindamycin treatment for bacterial vaginosis in pregnancy did not reduce the risk of late miscarriage or spontaneous very preterm birth, but did increase the risk of adverse events such as diarrhea and abdominal pain 6.
• Topical clindamycin cream has been shown to be a safe and effective treatment for bacterial vaginosis, with minimal risk to the fetus in pregnant patients 7.

Treatment of Bacterial Vaginosis During Pregnancy

• Bacterial vaginosis can be treated with oral or vaginal metronidazole or clindamycin, all of which provide high cure rates 7.
• Treatment of asymptomatic women with bacterial vaginosis is controversial, but may be justified in certain high-risk populations, such as pregnant women 7.
• Clindamycin and metronidazole are both effective treatments for bacterial vaginosis, but metronidazole is considered the reference agent 8.
• Treatment of the partner can reduce the risk of recurrence of bacterial vaginosis, although the disease is not strictly a sexually transmitted disease 8.