Is Amphotericin B safe during pregnancy?

Despite the fact that pregnancy is considered a condition with increased vulnerability to infections, including some life-threatening fungal infections, a proper assessment of anti-fungal medication is required. This can only be done under the supervision of a trained medical officer (doctor/physician).

Even to date, antifungal prescription remains a challenge in pregnant women. This is due to several uncertainties regarding fetal toxicity and altered maternal pharmacokinetic parameters (these can either affect drug efficacy or increase maternal and fetal toxicity).

Recent research has shown the teratogenic effect of high-dose fluconazole when administered during the first trimester. It has been suggested only to be used at a single low dose in this important stage of pregnancy. Recent studies have also proved itraconazole and lipidic derivatives of amphotericin B as relatively safer medication strategies during such stages. In fact, amphotericin B is still the first-choice drug, despite its well-established toxicity (see also: List of side effects of Amphotericin B).

In many cases, due to limited absorption, topical drugs are used throughout pregnancy. Certain newer antifungal drugs like posaconazole and echinocandins require more clinical data validation before considered safe for prescription during pregnancy.

See also:

References:

  • Benoît Pilmis, Vincent Jullien, Jack Sobel, Marc Lecuit, Olivier Lortholary, Caroline Charlier, Antifungal drugs during pregnancy: an updated review, Journal of Antimicrobial Chemotherapy, Volume 70, Issue 1, January 2015, Pages 14–22, https://doi.org/10.1093/jac/dku355

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