Butoconazole is minimally absorbed systemically (5.5%). Clinical trials suggest relative safety with use during the second and third trimesters of pregnancy (King et al, 1998). Clinical trials suggest relative safety with use during the second and third trimesters of pregnancy (King et al, 1998). There are currently no human data to determining safety during pregnancy. (King et al, 1998)Systemic (oral/IV) antifungal medications are used to treat serious fungal infections, such as meningitis. Cryptococcal meningitis is an infection that apparently does not cross the placenta (Chen et al, 1996), but failure to treat can compromise maternal health and thus the health of the fetus. Because of their toxicity, use of systemic antifungals during pregnancy is limited to life threatening infections. There is relatively little data on the more potent systemic antifungals. However, the triazole class of systemic antifungals (including fluconazole and itraconazole) are less toxic alternatives and therefore have been studied more commonly in pregnant women. This review will concentrate on oral and IV preparations of systemic antifungal medications that have been well studied during pregnancy. This comparison will highlight differences in toxicity and how they affect pregnancy.
spontaneous abortions (SAB) in women who were prescribed nystatin 120 days prior to pregnancy loss when compared to full term deliveries (RR=0.87, CI 0.6 1.2). Although these data do not suggest a risk to human pregnancy, the lack of controlled human studies makes it difficult to establish relative safety.
PDF VersionAntifungal use during pregnancy is common because pregnant women are more susceptible to fungal infections. In addition, pregnancy is more commonly associated with more serious systemic fungal infections, such as mycoses, that require treatment. There are three types of treatment that can be used for fungal infections: topical, vaginal and systemic/oral. Prescription and over the counter treatments are available for a variety of infections. Animal studies have suggested teratogenicity of some imidazoles in high oral doses, but not with topical use. Topical agents are absorbed less by the body when compared to oral preparations, and have not been found to be teratogenic (King et al 1998). Jick (1999) reported on 492 women exposed to various topical azoles (ketoconazole, miconazole and econazole). A relative risk of 2.1 (95% CI 0.7 6.8) was not statistically significant for an increased risk of congenital malformations, when compared to matched controls. There is some suggestion that ketoconazole and miconazole could inhibit testosterone synthesis in utero, which could potentially inhibit genital development of a male fetus. However, this has not been documented in any controlled studies. Symptoms include soreness, irritation, and discharge. Differential diagnoses (excluding sexually transmitted diseases) for symptoms of vaginal irritation include candida vulvovaginitis (VVC), bacterial vaginosis (BV), trichomoniasis, and atrophic vaginitis. VCC is one of the most common fungal infections, affecting 50% of women by age 25. Clotrimazole is minimally absorbed (3 10%). The Michigan Medicaid Surveillance study reported on 1086 pregnancies exposed to clotrimazole during Orange New Balance Running Shoes the first trimester (King et al, 1998). There were 74 pregnancies with a birth defect (RR=1.09, 95% CI 0.9 1.4), and 112 spontaneous abortions (RR=1.34, 95% CI 1.1 1.7). These data suggest a slight increase in spontaneous abortions, but no increase in New Balance Grey Orange Blue
birth defects, with first trimester exposure to clotrimazole. Clotrimazole is thought to be safe during the second and third trimesters of pregnancy (King et al, 1998). Czeizel et al (1999) studied the possible teratogenicity of clotrimazole for topical and vaginal therapy using a case control surveillance study of 18,515 exposed pregnancies during three specific time intervals; first month, second and third month, and fourth through ninth month. Using 32,804 controls, they determined that clotrimazole use was not associated with an increase in congenital anomalies (OR=0.72, 95% CI 0.54 0.95). Further research has indicated that the use of clotrimazole may have a protective effect on preterm delivery. Czeizel and Rockenbauer (1999) determined that the use of clotrimazole during pregnancy significantly reduced the incidence of preterm births (t=8.86, P,0.001). It is used topically (see above) and intravaginally for VVC treatment. Vaginal use has shown minimal systemic absorption (1.4%) (King et al, 1998). The Michigan Medicaid surveillance (Rosa et al 1987) reported on 2236 exposed pregnancies and 144 birth defects. These data do not support a significant increase in fetal malformations above the general population (RR=1.02, CI 0.9 1.2). The same surveillance study reported a slightly significant increase in spontaneous abortions in women who were prescribed miconazole 120 days before pregnancy loss, when compared with full term deliveries (RR=1.36, CI 1.1 1.6). Lack of controlled studies on the safety of miconazole use during pregnancy, however, does not provide an New Balance Black And Pink Shoes
Nystatin is a polyene antifungal and is available over the counter. Vaginal preparation is the only type of application available due to toxicity by IV or oral administration. Nystatin is poorly absorbed systemically after topical or mucosal application. Specific use of nystatin has not been studied during pregnancy. Animal studies do not show an increased in congenital malformations (Rosa et al, 1987). Surveillance studies by the Collaborative Perinatal Project and Collaborative Drug Surveillance program did not find an increase of congenital malformation with first trimester use. Rosa et al (1987) reported data from the Michigan Medicaid study on women who received prescriptions for nystatin during the first trimester of pregnancy. Of 848 pregnant women, 66 deliveries were linked to birth defects. Their results were not statistically significant for an increase in birth defects over the general population (RR=1.25, CI 0.97 1.6). Surveillance by the Michigan Medicaid study did not show a significant increase in New Balance Men's 412
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accurate estimate of potential risk.
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