As a special group, pregnant women may be exposed to infectious diseases during pregnancy, such as respiratory infections and infections in the urinary system, when the use of anti-bacterial drugs is inevitable. However, due to changes in the biological state of the pregnant woman and the potential impact of the drug on the foetus, the application of antibacterial drugs in the pregnant woman needs to be carefully weighed against the advantages and disadvantages in order to ensure that the effects of mother-to-child treatment are minimized while minimizing the adverse effects on the foetus.
The effects of physiological changes during pregnancy on drug metabolism The biological changes in pregnant women during pregnancy significantly affect the absorption, distribution, metabolic and excretion of drugs. For example, the slow pace of gastrointestinal wrinkles during pregnancy and the decrease in gastric acid genre may affect the rate and extent of absorption of oral drugs; increased blood capacity and lower plasma protein concentrations, resulting in higher dispersive drug volume and relatively higher concentrations; a change in hepatic enzyme activity that affects the metabolic rate of drugs; an increase in renal blood flow, an increase in renal filtration rates and an increase in the excretion of drugs. The combination of these changes makes the drug-based dynamics of antibacterial drugs in pregnant women different from those of non-pregnancy women, requiring dose and delivery intervals adapted to the characteristics of specific drugs to achieve effective therapeutic concentrations and avoid drug accumulation.
The placenta is an important part of the exchange of material between the mother and the foetus, and most antibacterial drugs can be trans-shipped to the foetus via placenta. The speed and extent of trans-shipment of drugs through placenta depend on such factors as the physico-chemical nature of the drug (e.g., molecular volume, lipid solubility, protein binding rate, etc.), blood infusion on the placenta and the permeability of the placental membrane. In general, medicines with high lipid solubility, low molecular content and low protein binding are easier to pass through placenta, which increases the risk of foetal exposure to drugs and may lead to adverse consequences such as foetal malformation, limited growth and development, and neurotoxicity.
The safeness of antibacterial drugs in pregnant women can be broadly classified into the following categories depending on the potential harm to the foetus: Contrast studies conducted in pregnant women have not found that drugs are harmful to the foetus, such as penicillin (e.g. penicillin G, ammonium sicillin, etc.), head bacterium (e.g. head plastering, furcin, etc.) and relatively safe use during pregnancy, as antibacterial drugs commonly used during pregnancy infections, which can be used to treat a wide range of bacterial infections, such as respiratory infections, skin soft tissue infections, etc., which generally have no significant adverse effects on the foetus, but use of these drugs is subject to medical advice and attention to dose and treatment procedures. Category B: Animal experiments do not show a risk to the foetus, but do not have sufficient comparative studies among pregnant women in humans; or animal experiments do show adverse effects on the foetus, but no evidence of harm is found in human pregnant women’s comparative studies. For example, Achrycin, which is often used to treat chlamydia and chlamydia infections during pregnancy, is relatively safe and effective; there is also Krincin, which can be used to treat anaerobic infections, such as pelvic anaerobic infections, but also requires careful use and close observation of maternal and fetal conditions. Category C: Animal experiments have shown adverse effects on the foetus, but insufficient comparative studies are available among pregnant women in humans and the potential benefits of the drug may outweigh the potential harm to the foetus. Such drugs need to weigh their pros and cons for use during pregnancy, such as fluorophenone (e.g., left-oxen salsa), which, although more effective in some bacterial infections, is generally not recommended for use during pregnancy, especially in the early stages of pregnancy, because of its possible adverse effects on the development of the foetal cartiloskeletal bone; aminocin (e.g., Quintaacin) may have ear and renal toxicity, with a potential risk to the foetus, and is used under close surveillance only when it is serious and there is no alternative to safer drugs. Category D: There is clear evidence of a danger to the human foetus, but in certain cases, if the pregnant woman suffers from a serious disease, use may be considered if the non-use of the drug could endanger the life of the pregnant woman. For example, tetracycline, which can lead to foetal colouring, dysentery development and skeletal growth inhibition, is banned during pregnancy; it can cause a grey baby syndrome and is generally not used in pregnant women, except in life-threatening situations and subject to monitoring of blood concentration, in order to minimize the risk to the foetus. Category X: Animal experiments and human studies have shown that drugs are seriously harmful to the foetus and that the risk of use during pregnancy is much greater than the potential benefits, and that such drugs are absolutely prohibited during pregnancy, such as Libavirin, which has teratogenic effects and is banned for pregnant women.
1. The use of drugs during pregnancy shall be based on the principle of “minimum effective dose, shortest effective course of treatment” and, to the extent possible, the selection of drugs that have a low impact on the foetus, avoiding unnecessary combinations and long-term large-dose drug use to reduce cumulative exposure to the foetus. 2. Before using drugs, details should be asked about the history of allergies, diseases and medicines used by pregnant women, and the need and safety of the drug should be assessed in a comprehensive manner, taking into account the pregnancy week and the severity of the condition. Non-pharmacological treatments, such as drinking water, rest, etc., can be used to observe changes in the condition before the use of antibacterial drugs is considered if the condition progresses. 3. The clinical symptoms, signs and laboratory test indicators of pregnant women, such as blood protocol, C reaction protein, etc., are closely monitored in the course of the drug use to assess the effectiveness of the treatment and to observe whether there have been any adverse medical effects, such as rashes, nausea, vomiting, damage to liver and kidney function, etc., and to adjust the treatment programme in a timely manner. For pregnant women requiring long-term use of anti-bacterial drugs, such as chronic infectious diseases (e.g. chronic renal diarrhea, etc.), there should be regular monitoring of the growth and development of the foetus, such as fetal ultrasound, in order to detect possible foetal abnormalities at an early stage.
The use of antibacterial drugs in the population of pregnant women needs to take full account of the biological changes during pregnancy, the placenta characteristics of the drug and its safety for the foetus. Clinicians should be familiar with the safe classification of all types of anti-bacterial drugs during pregnancy, carefully choose the appropriate drugs in the treatment of infectious diseases in pregnant women, and strictly follow the principles of the use of medicines and care, while ensuring the health of pregnant women, minimize the potential harm to the foetus and balance mother-to-child treatment with the safety of the foetus. At the same time, strengthening health education for pregnant women and raising their awareness of the rational use of anti-bacterial drugs, as well as avoiding self-use or substance abuse, are important elements in ensuring the safety of medication during pregnancy.
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