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Notice to Readers: Updated Recommendations for Antimicrobial
Prophylaxis Among Asymptomatic Pregnant Women After Exposure to
Bacillus anthracis
The antimicrobial of choice for initial prophylactic therapy among
asymptomatic pregnant women exposed to Bacillus
anthracis is ciprofloxacin, 500 mg twice a day for 60
days. In instances in which the specific B.
anthracis strain has been shown to be
penicillin-sensitive, prophylactic therapy with amoxicillin, 500 mg three times a day
for 60 days, may be considered. Isolates of B.
anthracis implicated in the current bioterrorist attacks are susceptible to penicillin in laboratory tests, but may
contain penicillinase activity (2). Pencillins are not recommended for treatment of
anthrax, where such penicillinase activity may decrease their effectiveness.
However, penicillins are likely to be effective for preventing anthrax, a setting where
relatively few organisms are present. Doxycycline should be used with caution in
asymptomatic pregnant women and only when contraindications are indicated to the use of
other appropriate antimicrobial drugs.
Pregnant women are likely to be among the increasing number of
persons
receiving antimicrobial prophylaxis for exposure to
B. anthracis. Clinicians, public health officials, and women who are candidates for treatment should weigh
the possible risks and benefits to the mother and fetus when choosing an antimicrobial
for postexposure anthrax prophylaxis. Women who become pregnant while
taking antimicrobial prophylaxis should continue the medication and consult a
health-care provider or public health official to discuss these issues.
No formal clinical studies of ciprofloxacin have been performed during
pregnancy. Based on limited human information, ciprofloxacin use during pregnancy is unlikely
to be associated with a high risk for structural malformations in fetal development.
Data on ciprofloxacin use during pregnancy from the Teratogen Information
System indicate that therapeutic doses during pregnancy are unlikely to pose a
substantial teratogenic risk, but data are insufficient to determine that there is no risk
(1). Doxycycline is a tetracycline antimicrobial. Potential dangers of tetracyclines to
fetal development include risk for dental staining of the primary teeth and concern
about possible depressed bone growth and defective dental enamel. Rarely, hepatic
necrosis has been reported in pregnant women using tetracyclines. Penicillins generally
are considered safe for use during pregnancy and are not associated with an
increased risk for fetal malformation. Pregnant women should be advised that
congenital malformations occur in approximately 2%--3% of births, even in the absence of known
teratogenic exposure.
Friedman JM, Polifka JE. Teratogenic effects of drugs: a resource for clinicians
(TERIS). Baltimore, Maryland: Johns Hopkins University Press, 2000:149--95.
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