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How to safely take antibiotics during pregnancy

No one loves taking antibiotics: Between the side effects and the concerns over antibiotic resistance, there are always risks that come with popping these bacteria-killing medications.

This is especially true during pregnancy, when your immune system is compromised and many common medications are off-limits due to concerns about their effects on your growing baby. Sometimes, though, antibiotics are necessary; if you have a bacterial infection, they may be the only way to get healthy again.

If you end up needing to take antibiotics during your pregnancy—it can be safe to do so…but not all antibiotics are recommended while you’re expecting. Here’s what you need to know.

Are antibiotics safe in pregnancy? 

It depends on the antibiotic and how it’s classified by the Food and Drug Administration (FDA). Certain antibiotics, like those in the tetracycline class, should always be avoided, as should ciprofloxacin, fluoroquinolones, and streptomycin, among others. Use of these antibiotics during pregnancy has been linked to fetal bone weakening and other developmental defects.

That still leaves you with a lot of other frontline options, though, many of which are considered safe by OB-GYNs and primary care providers alike.

“Most antibiotics are category B drugs, meaning no long-term negative effects have ever been seen [in pregnant women] and there have been no issues in animal studies,” says G. Thomas Ruiz, MD, the OB-GYN lead at MemorialCare Orange Coast Medical Center.

What antibiotics are safe during pregnancy?

Some common antibiotic that are likely safe to take during pregnancy include:

Drug name Common side effects Trimester Get coupon
Penicillins such as Amoxil (amoxicillin) and Augmentin Stomach problems, itching, hives All

Get Amoxil coupon

Get augmentin coupon

Cephalosporins, including Keflex Stomach problems, diarrhea, yeast infection All Get Keflex coupon
Clindamycin Stomach problems, joint pain, heartburn All Get clindamycin coupon
Erythromycin Stomach problems, diarrhea, dizziness All Get erythromycin coupon

Other antibiotics can be safe at certain times during pregnancy. Dr. Ruiz says Bactrim shouldn’t be prescribed after 32 weeks because it can affect your baby’s bilirubin levels and cause jaundice; on the other hand, the CDC recommends that nitrofurantoin not be prescribed until after the first trimester.

When prescribing antibiotics to a pregnant patient, most providers stick with drugs that have a long history of effectiveness and have shown themselves to be safe. Most of the drugs considered harmful to a developing fetus have perfectly safe alternatives that provide the same benefits, making them largely unnecessary for use during pregnancy. Your provider will also use discretion to prescribe the most appropriate antibiotic for your particular infection.

Why you might need to take antibiotics during pregnancy

You’re doing everything you can to stay healthy during your pregnancy, but the reality is that pregnant women are more susceptible to both viral and bacterial infections. You may find that a run-of-the-mill cold (the third one you’ve caught this winter!) turns into bronchitis or sinusitis, requiring an antibiotic to fully clear the illness.

Even more likely is the occurrence of certain types of infections that are known to plague all women… but especially pregnant women.

Yeast infections and bacterial vaginosis are more common in pregnancy,” says Rochelle Arbuah-Aning, MD, an OB-GYN at Mercy Medical Center in Baltimore. “The hormonal changes of pregnancy can disrupt the normal pH balance of the vagina.”

Meanwhile, the likelihood of having a bladder or urinary tract infection (UTI) during pregnancy may be as high as 8%, according to the CDC. Some pregnant women may not even notice symptoms of a UTI, which is one of the conditions screened for during prenatal visits.

What happens if you don’t treat bacterial infections during pregnancy?

If you’re feeling squeamish about the idea of taking a prescribed antibiotic, know that for many conditions, the benefits of taking it are likely to far outweigh the risks. Some conditions may resolve without using oral antibiotics.

“Pregnancy is a relatively immune-compromised state and you are more susceptible to rapid spread with bacterial infections,” Dr. Ruiz says. “Pneumonias are worse, UTIs are worse…really [any infection during pregnancy] will be worse than when you’re not pregnant.”

According to Dr. Ruiz, what starts as a typical UTI can quickly progress to a kidney infection and, possibly, septicemia if left untreated. Although taking any kind of medication during pregnancy comes with a dose of extra caution, sometimes not taking a drug is more dangerous.

“In general, the risk of untreated infection in pregnancy is much greater than the risks of antibiotic use, especially if the antibiotic is safe to use in pregnancy,” says Dr. Arbuah-Aning, who adds that antibiotics should be taken for the shortest effective duration, and other therapies (like vaginal creams for treatment of antibiotic-induced yeast infections) can and should be used, if necessary. 

You and your provider can discuss treatment options and their risks, benefits, and adverse effects for medical conditions and determine the best course of action.

RELATED: 15 home remedies for UTI prevention and treatment

Things to keep in mind when taking antibiotics during pregnancy

The majority of safe antibiotics during pregnancy can be taken with food, which is good news since the most often reported side effect of antibiotics is gastrointestinal distress.

“A common reason why women have difficulty taking antibiotics in pregnancy is nausea and vomiting,” says Dr. Arbuah-Aning, “so do not take antibiotics on an empty stomach—take with food or milk instead.”

If you’re really struggling, Dr. Arbuah-Aning says your provider can prescribe anti-nausea medication to be taken 30 minutes before taking your antibiotics. In the meantime, you should continue taking your prenatal vitamins and make sure you complete the full course of antibiotics (even if you start feeling better before they’re finished) to decrease your risk of prolonged infection and antibiotic resistance.

And remember that if you have any concerns, always feel free to reach out to your prenatal provider.

“If you’re going to an urgent care doctor or PCP and they’re not sure [if what they’re about to prescribe you is safe during pregnancy], check with your OB-GYN,” Dr. Ruiz says. “Call, send an email, leave a message with the on-call doctor—do whatever you need to do.”