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Prophylaxis and Treatment of Anthrax in Pregnant Women

Meaney-Delman, Dana MD, MPH; Rasmussen, Sonja A. MD, MS; Beigi, Richard H. MD, MSc; Zotti, Marianne E. DrPH; Hutchings, Yalonda MD, MPH; Bower, William A. MD; Treadwell, Tracee A. DVM, MPH; Jamieson, Denise J. MD, MPH

doi: 10.1097/AOG.0b013e3182a5fdfd

OBJECTIVE: To review the safety and pharmacokinetics of antimicrobials recommended for anthrax postexposure prophylaxis and treatment in pregnant women.

DATA SOURCES: Articles were identified in the PubMed database from inception through December 2012 by searching the keywords ([“pregnancy]” and [generic antibiotic drug name]). Additionally, we searched and conducted hand searches of references from REPROTOX, TERIS, review articles, and Briggs' Drugs in Pregnancy and Lactation.

METHODS OF STUDY SELECTION: Articles included in the review contain primary data related to the safety and pharmacokinetics among pregnant women of 14 antimicrobials recommended for anthrax postexposure prophylaxis and treatment (amoxicillin, ampicillin, chloramphenicol, clindamycin, ciprofloxacin, doripenem, doxycycline, levofloxacin, linezolid, meropenem, moxifloxacin, penicillin, rifampin, and vancomycin).

TABULATION, INTEGRATION, AND RESULTS: The PubMed search identified 3,850 articles for review. Reference hand searching yielded nine additional articles. In total, 112 articles met the inclusion criteria.

CONCLUSIONS: Overall, safety and pharmacokinetic information is limited for these antimicrobials. Although small increases in risks for certain anomalies have been observed with some antimicrobials recommended for prophylaxis and treatment of anthrax, the absolute risk of these antimicrobials appears low. Given the high morbidity and mortality associated with anthrax, antimicrobials should be dosed appropriately to ensure that antibiotic levels can be achieved and sustained. Dosing adjustments may be necessary for the β-lactam antimicrobials and the fluoroquinolones to achieve therapeutic levels in pregnant women. Data indicate that the β-lactam antimicrobials, the fluoroquinolones, and, to a lesser extent, clindamycin enter the fetal compartment, an important consideration in the treatment of anthrax, because these antimicrobials may provide additional fetal benefit in the second and third trimesters of pregnancy.

Based on limited data, antimicrobials for anthrax prophylaxis and treatment pose low risk to pregnant women and neonates but may require dosing adjustments.

Centers for Disease Control and Prevention, Atlanta, Georgia; and the Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Reproductive Infectious Diseases and Obstetric Specialties, Magee-Women’s Hospital of the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.

Corresponding author: Dana Meaney-Delman, MD, MPH, 1600 Clifton Road, Mailstop C12, Atlanta GA 30333; e-mail:

Financial Disclosure The authors did not report any potential conflicts of interest.

Supported by funds from the Centers for Disease Control and Prevention, Office for Public Health Preparedness and Response.

The authors thank Mirelys Rodriguez, Angelika Claussen, and Angela Herrington for assistance with data collection and Rebecca Satterthwaite for her expertise in topic development.

The findings and conclusions are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

© 2013 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.