New recommendations for antibiotic prophylaxis of anthrax in women during pregnancy and lactation

The American University of Obstetrics and Gynecology has published recommendations on the antibiotic prophylaxis of anthrax in women during pregnancy and lactation, according to which amoxicillin can be prescribed in case of danger of infection by anthrax spores. A prerequisite is confirmation of the sensitivity of Bacillus anthracis to penicillin.

Members of the Obstetrics and Gynecology Committee of the American University of Obstetrics and Gynecology believe that the safety data for ciprofloxacin, the drug of choice for antibiotic prophylaxis of anthrax in pregnant women, are insufficient so far. At the same time, the Committee notes that there is sufficient reliable data available on the safety of amoxicillin during pregnancy.

For people who do not have symptoms of the disease and if the risk of infection is low, antibiotics are not prescribed until a microbiological confirmation of contact with the causative agent of the disease is obtained. coal.

Ciprofloxacin and other fluoroquinolones are generally not used during gestation and lactation, because during the animal study data were obtained on the high risk of arthropathy. However, there is no convincing evidence of teratogenicity of fluoroquinolones in humans. Despite this, the risk of possible morbidity and mortality from anthrax greatly exceeds the risk of arthrotoxicity in the fetus.

Treatment should begin with the appointment of ciprofloxacin 500 mg 2 times a day.

Thus, the American University of Obstetrics and Gynecology notes the possibility of prescribing amoxicillin 500 mg x 3 times a day only with confirmation of the sensitivity of pathogens to penicillin. The duration of the two treatment regimens should be 60 days.

If ciprofloxacin and amoxicillin are contraindicated (for example, a history of allergic reactions), doxycycline can be used. However, tetracyclines belong (according to the FDA classification) to category D (that is, there is evidence of an adverse effect on the fetus) and, accumulating in bones and teeth buds, cause their demineralization + have a high risk of hepatotoxicity. Patients allergic to penicillin may be desensitized.

The Centers for Disease Control and Prevention (CDC) and the United States Food and Drug Administration (FDA) are satisfied with these recommendations.

In conclusion, the American University of Obstetrics and Gynecology emphasizes that in all cases, the risk of anthrax with confirmed contact with the pathogen considerably exceeds any possible risk to the fetus due to antibiotics.