Antibiotics
More than half of pregnant women are usually affected by odontogenic pain affects. Pain often accompanies periapical
or pulp infections and increases the risks to pregnant patients and their fetuses
(Aliabadi et al, 2022).
According to studies, the use of antibiotics in some cases such as surgery to remove benign tumours, surgery for extraction of impacted teeth, surgery for an implant, bone grafting, and periapical surgery, is prescribed for patients. In treatment of acute infections like invasive localized periodontitis, ulcerative gingivitis, acute apical abscess, periodontal abscess, peri-implantitis, cellulite and pericoronitis, the antibiotics are also suggested (Koyuncuoglu et al, 2017).
Antibiotics have high fat solubility and low molecular weight. This maintains a high concentration of antibiotics in the blood and facilitates their transfer through the placental barrier. In addition, oral antibiotics are safer than Systemic antibiotics because of their lower absorption (Aliabadi et al, 2017).
Limited information indicates that amoxicillin produces low levels in milk that are not expected to cause adverse effects in breastfed infants. Occasionally, rash and disruption of the infant's gastrointestinal flora, resulting in diarrhea or thrush, have been reported, but these effects have not been adequately evaluated. Amoxicillin is acceptable in nursing mothers (Drugs and Lactation database 2021).
It is important to note that using this medication during the third trimester increases the risk of a serious condition called necrotizing enterocolitis in the infant. Although there is a low risk of infection overall, this combination medication shouldn’t be used during the third trimester of pregnancy (Kossara, M 2023).
The therapeutic dosage of the drug is 600 mg or 300 mg every 8 hours orally or intravenously. The drug is also a proffered alternative for prophylaxis in penicillin-allergic patients for prophylaxis (Nadig and Taylor, 2018).
Clindamycin gets into breastmilk in small amounts when women are given clindamycin orally (by mouth) or intravenously (IV). In those situations, clindamycin might cause some gastrointestinal (GI) effects in a breastfeeding (e.g., nausea, diarrhea, stomach pain, vomiting, diaper rash, thrush, or rarely bloody stools) (Mother to baby 2023).
There is not enough clinical information on the safety of this category (B). While clindamycin is not associated with outcomes of pregnancy and abortion on the fetus, its use has been associated with congenital cardiovascular and musculoskeletal abnormalities (Muanda, Sheehy and Berard, 2017).
Last updated: 2024 August 26According to studies, the use of antibiotics in some cases such as surgery to remove benign tumours, surgery for extraction of impacted teeth, surgery for an implant, bone grafting, and periapical surgery, is prescribed for patients. In treatment of acute infections like invasive localized periodontitis, ulcerative gingivitis, acute apical abscess, periodontal abscess, peri-implantitis, cellulite and pericoronitis, the antibiotics are also suggested (Koyuncuoglu et al, 2017).
Antibiotics have high fat solubility and low molecular weight. This maintains a high concentration of antibiotics in the blood and facilitates their transfer through the placental barrier. In addition, oral antibiotics are safer than Systemic antibiotics because of their lower absorption (Aliabadi et al, 2017).
Common antibiotics that are prescribed in dental practice
Amoxicillin
Amoxicillin is a penicillin antibiotic that acts against Gram-negative bacilli. Amoxicillin is commonly considered to be the first line of treatment in nonallergic patients. It is the most frequently prescribed antibiotic accounting. Some practitioners also prefer to administer the combination of amoxicillin and metronidazole or amoxicillin/clavulanate to treat odontogenic infection. The therapeutic dosage for amoxicillin is 500 mg every 8 hours or 1000 mg every 12 hours (Ahmadi et al 2021).Administration in pregnancy and breastfeeding
According to the statement of the FDA, no relation has yet been reported linking the implementation of amoxicillin during pregnancy to the miscarriage, the main birth defects, or fetal and maternal side effects. The same results were reported by the Teratogen System Information (TERIS) by examination of 25,000 implementation of penicillin in pregnancy and the increased danger of pregnancy outcomes (Ather et al, 2020).Limited information indicates that amoxicillin produces low levels in milk that are not expected to cause adverse effects in breastfed infants. Occasionally, rash and disruption of the infant's gastrointestinal flora, resulting in diarrhea or thrush, have been reported, but these effects have not been adequately evaluated. Amoxicillin is acceptable in nursing mothers (Drugs and Lactation database 2021).
Amoxicillin with clavulanic acid (co-amoxiclav)
Amoxicillin with clavulanic acid (co-amoxiclav) is a broad-spectrum antibiotic that is believed to be the second most prescribed antibiotic by dentists. There is no evidence to suggest that taking this combination medicine at therapeutic levels during pregnancy increases the risk of fetal or congenital abnormalities.It is important to note that using this medication during the third trimester increases the risk of a serious condition called necrotizing enterocolitis in the infant. Although there is a low risk of infection overall, this combination medication shouldn’t be used during the third trimester of pregnancy (Kossara, M 2023).
Clindamycin
Clindamycin is a broad-spectrum bacteriostatic antibiotic that covers both aerobic and anaerobic pathogens. As showed by the previous investigations, nearly 75% of all bacteria causing odontogenic infections are sensitive to the drug. Clindamycin could be prescribed in the case of persistent infections, as it has more efficacies in comparison with penicillin and metronidazole. Besides, it has been shown that the bacterial resistance rates against penicillin are higher comparing to clindamycin (Kehrenberg et al, 2005).The therapeutic dosage of the drug is 600 mg or 300 mg every 8 hours orally or intravenously. The drug is also a proffered alternative for prophylaxis in penicillin-allergic patients for prophylaxis (Nadig and Taylor, 2018).
Administration in pregnancy and breastfeeding
It is unlikely that using clindamycin increases the chance of birth defects. Several human studies as well as animal studies have not shown an increased chance of birth defects. Several studies have not found an increased chance of pregnancy complications from clindamycin use in the second or third trimester (Mother to baby 2023).Clindamycin gets into breastmilk in small amounts when women are given clindamycin orally (by mouth) or intravenously (IV). In those situations, clindamycin might cause some gastrointestinal (GI) effects in a breastfeeding (e.g., nausea, diarrhea, stomach pain, vomiting, diaper rash, thrush, or rarely bloody stools) (Mother to baby 2023).
There is not enough clinical information on the safety of this category (B). While clindamycin is not associated with outcomes of pregnancy and abortion on the fetus, its use has been associated with congenital cardiovascular and musculoskeletal abnormalities (Muanda, Sheehy and Berard, 2017).
Metronidazole
Metronidazole is a very effective category B2 drug derived from nitroimidazole. The antibiotic metronidazole is prescribed against anaerobic bacteria, usually in combination with penicillin, to treat odontogenic infections.Administration in pregnancy
More recent studies could find no evidence that using metronidazole during pregnancy increases the chance for birth defects. The current data do not support an increased chance for birth defects or other harmful effects on the baby. Based on the data available, metronidazole is not expected to increase the chance for other pregnancy complications. One study looked at over 900 women who had taken metronidazole sometime during their pregnancy and there was no increased chance for preterm delivery (birth before 37 weeks of pregnancy), low birth weight, or birth defects reported (Mother to baby 2022).Administration in breastfeeding
Metronidazole gets into breast milk in relatively large amounts. However, the amount in breastmilk is below the dose given to treat young infants who were able to tolerate this drug. If metronidazole is taken during breastfeeding, a nursing child might experience loose stools, especially when the drug is given directly into a vein (intravenously) to the person who is breastfeeding. Some babies might develop a yeast infection (diaper rash or thrush). There are also reports on breastfed babies without reported side effects (Mother to baby 2022).References
Aliabadi, T, Saberi, E, Tabatabaie, M, Tahmasebi, E 2022, ‘Antibiotic use in endodontic treatment during pregnancy: A narrative review’, European Journal of Translational Myology, vol.32, no.4, pp.1-8.
Ahmadi H, Ebrahimi A, Ahmadi F. Antibiotic Therapy in Dentistry. Int J Dent. 2021 Jan 28;2021:6667624. doi: 10.1155/2021/6667624.
Ather, A, Zhong, S, Rosenbaum, A, Quinonez, R, Khan, A 2020, ‘Pharmacotherapy during Pregnancy: An Endodontic Perspective’, Journal of Endodontics, vol. 46, no. 9, pp.1185-1194.
Clindamycin, Mother to Baby (2023), https://mothertobaby.org/fact-sheets/clindamycin-pregnancy/
Drugs and Lactation Database (2021), LactMed, https://www.ncbi.nlm.nih.gov/books/NBK501922/
Kehrenberg, C, Schwarz, S, Jacobsen, L, Hansen, L, Vester, B 2005, ‘A new mechanism for chloramphenicol, florfenicol and clindamycin resistance: methylation of 23S ribosomal RNA at A2503’, Molecular Microbiology, vol.57, no.4, pp.1064-1073.
Kossara, M 2023, ‘Use of Antibiotics in Pregnant Women for the Treatment of Dental Infections: A Short Review’, Reports on Global Health Research, vol.6, no.1, pp.1-4.
Koyuncuoglu CZ, Aydin M, Kirmizi NI, Aydin V, Aksoy M, Isli F, Akici A. Rational use of medicine in dentistry: do dentists prescribe antibiotics in appropriate indications? Eur J Clin Pharmacol. 2017. Aug;73(8):1027-1032. doi: 10.1007/s00228-017-2258-7.
Metronidazole, Mother to Baby (2022), https://mothertobaby.org/fact-sheets/metronidazole-flagyl-pregnancy/pdf/
Muanda, F, Sheehy, O, Berard, A 2017, ‘Use of antibiotics during pregnancy and the risk of major congenital malformations: a population-based cohort study’, British Journal of Clinical Pharmacology, vol.83, no.11, pp.2557-2571.
Nadig, K, Taylor, N 2018, ‘Management of odontogenic infection at a district general hospital’, British Dental Journal, vol.224, no.12, pp.962-966.
Ahmadi H, Ebrahimi A, Ahmadi F. Antibiotic Therapy in Dentistry. Int J Dent. 2021 Jan 28;2021:6667624. doi: 10.1155/2021/6667624.
Ather, A, Zhong, S, Rosenbaum, A, Quinonez, R, Khan, A 2020, ‘Pharmacotherapy during Pregnancy: An Endodontic Perspective’, Journal of Endodontics, vol. 46, no. 9, pp.1185-1194.
Clindamycin, Mother to Baby (2023), https://mothertobaby.org/fact-sheets/clindamycin-pregnancy/
Drugs and Lactation Database (2021), LactMed, https://www.ncbi.nlm.nih.gov/books/NBK501922/
Kehrenberg, C, Schwarz, S, Jacobsen, L, Hansen, L, Vester, B 2005, ‘A new mechanism for chloramphenicol, florfenicol and clindamycin resistance: methylation of 23S ribosomal RNA at A2503’, Molecular Microbiology, vol.57, no.4, pp.1064-1073.
Kossara, M 2023, ‘Use of Antibiotics in Pregnant Women for the Treatment of Dental Infections: A Short Review’, Reports on Global Health Research, vol.6, no.1, pp.1-4.
Koyuncuoglu CZ, Aydin M, Kirmizi NI, Aydin V, Aksoy M, Isli F, Akici A. Rational use of medicine in dentistry: do dentists prescribe antibiotics in appropriate indications? Eur J Clin Pharmacol. 2017. Aug;73(8):1027-1032. doi: 10.1007/s00228-017-2258-7.
Metronidazole, Mother to Baby (2022), https://mothertobaby.org/fact-sheets/metronidazole-flagyl-pregnancy/pdf/
Muanda, F, Sheehy, O, Berard, A 2017, ‘Use of antibiotics during pregnancy and the risk of major congenital malformations: a population-based cohort study’, British Journal of Clinical Pharmacology, vol.83, no.11, pp.2557-2571.
Nadig, K, Taylor, N 2018, ‘Management of odontogenic infection at a district general hospital’, British Dental Journal, vol.224, no.12, pp.962-966.