Cefuroxime Pregnancy and Breastfeeding Warnings
Cefuroxime Pregnancy Warnings
In one study of seven pregnant women, cefuroxime 750 mg intravenously one to eight hours before delivery revealed passage of the drug across the placenta. The average maternal plasma, amniotic fluid, umbilical cord, and neonatal plasma cefuroxime levels ranged from 0 to 24, 1.2 to 18.0, less than 2.0 to 11.0, and less than 2.0 to 3.6 mcg per mL, respectively. No adverse effects on the fetus or neonates were observed. The Michigan Medicaid surveillance study showed no association between cefuroxime and congenital defects. This report is a summary of information from a study in which 143 of 229,000 pregnant women from 1985 to 1992 received cefuroxime. There were three defects observed relative to six expected. Neither cleft palate nor cardiovascular defects were observed. These data do not support an association between cefuroxime and congenital defects. In one study of 78 pregnant women between 15 to 35 weeks' gestation who were given cefuroxime 750 mg intravenously 8 to 138 minutes prior to delivery, the average fetal plasma levels were 7.4 mcg per mL (normal fetuses), 6.2 mcg per mL (hydropic fetuses), and 4.9 mcg per mL (oligohydramniotic fetuses). These data show that transplacental passage is significantly reduced in the presence of oligohydramnios. Incidentally, the plasma clearance of cefuroxime is significantly increased and the elimination half-life significantly decreased during pregnancy.
Cefuroxime has been assigned to pregnancy category B by the FDA. Animal studies failed to reveal evidence of fetal harm. There are no controlled data in human pregnancy. Cefuroxime should only be given during pregnancy when need has been clearly established.
Cefuroxime Breastfeeding Warnings
Although the human milk concentration of some cephalosporins is relatively low, some experts warn about the possibility of unknown direct effects on the nursing infant, modification of neonatal bowel flora, and difficulty in the interpretation of culture results in the evaluation of suspected neonatal infection.
Cefuroxime is excreted into human milk. Adverse effects in the nursing infant are unlikely. Other cephalosporins have been classified as compatible with breast-feeding by the American Academy of Pediatrics.
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