2172 Antiinfective agents

Local antibiotics

Pharmacology and toxicology

Fusidin acid is an antibiotic used almost exclusively topically, for which, despite it having been introduced to the market quite some time ago, there are no systematic studies on its tolcrability during pregnancy. It has only a narrow effectiveness spectrum against gram-positive bacteria (staphylococci), and for this reason is not recommended for non-specific treatment. Basically, every external antibiotic therapy must be critically examined from the perspective of whether there is a bacterial infection that might possibly be more effectively treated systemically. In addition, sensibilization and the development of bacteriological resistance need to be considered with topical antibiotic treatment. With acne therapy, the bacteriostatic sodium sulfacetamide, mostly in combination with sulfur preparations, is topically applied. The skin resorption is approximately 4%, according to Akhavan (2003). There are no safety data for the application of sodiumsulfacetamide and silversulfadiazine during pregnancy; the latter is used as prophylaxis against infected burns. Twelve pregnant women topically treated with neomycin (seven exposures in the first trimester) were reported. Follow-up did not mention developmental disorders (Akhavan 2003).

No data are available related to the specific locally-used antibiotics framycetine, meclocycline, mupirocine, nadifloxacine, and tyrothricine.

There has been no suspicion of teratogenic effects with any topically used anti-infectives. Antibiotics that can be used systematically can be used topically (see Chapter 2.6).

Local antimycotics

See Chapter 2.6.

Local antivirals

No risk during pregnancy has been identified for the virostatic acyclovir (see also extensive experience with sytemic use during pregnancy, Chapter 2.6) or for local treatment for condylomata acuminata (venereal warts) with podophyllotoxin, a plant-based mitosis inhibitor (Robert 1994, Bargman 1988, Kami 1980).

There are reports on eight pregnant women with condylomata acuminata who were treated with imiquimode, an immune modulator and virostatic for topical application. Two were exposed during the first trimester; all newborn were healthy (Einarson 2006, Maw 2004).

There is insufficient experience available using the virustatics sodium foscarnet, idoxuridine, penciclovir, tromantadine, and vidarabine. For further information concerning individual anti-infectives, see Chapter 2.6.

Recommendation. Anti-infectives may be used on the skin, the mucosa, and even in the eye and ear for the appropriate indications during pregnancy. For theoretical reasons, the best-tested substances should also be the first choice for topical usage; however, chloramphenicol should not be used. For usage over wide skin areas, preparations should be viewed as critically as systemic usage because of the danger of absorbing larger amounts of the agent. For condylomata acuminata during pregnancy, cryotherapy or trichloroacetic acid are the treatments of choice.

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