Common antibiotics used for treatment of a pulmonary exacerbation in people with CF
Medication/class | Route of administration | Target pathogen | Observations/considerations | Use in pregnancy | Use in lactation |
Tobramycin Aztreonam Levofloxacin Colistimethate | Inhaled | Pseudomonas aeruginosa | Little to no systemic absorption with inhaled route | Yes | Yes |
Fluoroquinolones | Oral or i.v. | Pseudomonas aeruginosa | Low risk of fetal cartilage damage and generally avoided during pregnancy | Avoid | Yes |
Aminoglycosides | i.v. | Pseudomonas aeruginosa | Generally avoided and used if severe infection or critically ill given eight cranial nerve toxicity with some aminoglycosides | Avoid | Yes |
Piperacillin/tazobactam | i.v. | Pseudomonas aeruginosa | Considered low risk in pregnancy and lactation | Yes | Yes |
Cephalosporins | i.v. | Pseudomonas aeruginosa/MSSA | Considered low risk in pregnancy and lactation | Yes | Yes |
Carbapenems | i.v. | Pseudomonas aeruginosa/MSSA | CF women have been shown to be more likely to develop severe pre-eclampsia, and carbapenems lower the seizure threshold | Yes | Yes |
Penicillins | Oral or i.v. | MSSA | Considered low risk in pregnancy and lactation | Yes | Yes |
Trimethoprim-sulfamethoxazole | Oral or i.v. | MRSA | Trimethoprim may impair folic acid metabolism; sulfamethoxazole has been associated with fetal haemolytic anaemia and neonatal hyperbilirubinaemia | Avoid | Yes |
Vancomycin | i.v. | MRSA | Limited human data during first trimester but no evidence of teratogenesis | Yes | Yes |
Linezolid | Oral or i.v. | MRSA | Infants exposed during lactation should be monitored for diarrhoea or vomiting | Yes | Yes |