Lorna Kemble Pregnancy and Birth

262 Cephalosporins

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Pharmacology and toxicology

Cephalosporins also belong to the ß-lactam antibiotics, but their pharmacokinetic and antibacterial properties are different from those of penicillins. They may cause hypersensitivity reactions. Some patients with penicillin allergy also react with cephalosporins. Cephalosporins are classified according to their antimicrobial activity.

First-generation cephalosporins are cefaclor, cefradin, Cefadroxil, cefalexin, cefalotine, and cefazolirt.

Second-generation cephalosporins are cefamandole, ceftnetazol, cefoxitin, and cefuroxime.

Third-generation cephalosporins are cefdinir, Cefetamet, Cefixime, cefodizim, cefoperazone, cefotaxime, cefotetan, cefpirome, Cefpodoxime, cefprozil, cefsulodin, ceftazidime, Ceftibuten, ceftizoxime, ceftriaxone, and latamoxef.

Cefipime is a fourth-generation cephalosporin.

Second- and third-generation cephalosporins, especially cefotetan, are increasingly associated with severe immune hemolytic anemia (Garratty 1999).

Cephalosporins cross the placenta, and can reach therapeutic levels in amniotic fluid and fetal tissues (Mitchell 2001). Elimination in pregnant women is faster, and it may be necessary to adjust dosage (Heikkilä 1994).

There is no evidence of teratogenic or embryo/fetotoxic properties (Czeizel 200IB, Berkovitch 2000).

In a recent study, Manka (2000) reported that the physical and mental development was normal in children of women who had been treated with ccfuroxim at any time during pregnancy.

Recommendation. Cephalosporins can be used safely during pregnancy if needed. The older cephalosporins are preferred.