Pharmacokinetics and Target Attainment of Antimicrobial Drugs Throughout Pregnancy: Part I—Penicillins

Pharmacokinetics and Target Attainment of Antimicrobial Drugs Throughout Pregnancy: Part I—Penicillins

Background and Objective Pharmacokinetics (PK) are severely altered in pregnant women due to changes in volume of distribution (Vd) and/or drug clearance (CL), affecting target attainment of antibiotics in pregnant women. This review is part of a series that reviews literature on the description of...

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Bibliographic Details
Published in:Clinical pharmacokinetics Vol. 62; no. 2; pp. 221 - 247
Main Authors: Hesse, M. R., Prins, J. R., Hooge, M. N. Lub-de, Winter, H. L. J., Kosterink, J. G. W., Touw, D. J., Mian, Paola
Format: Journal Article
Language:English
Published: Cham Springer International Publishing 01-02-2023
Springer Nature B.V
Subjects:
Acids
Amoxicillin
Ampicillin
Anti-Bacterial Agents - pharmacokinetics
Antibiotics
Antimicrobial agents
Bacterial infections
Drug dosages
Female
Humans
Infections
Internal Medicine
Investigations
Literature reviews
Medicine
Medicine & Public Health
Penicillin
Penicillins - pharmacokinetics
Pharmacodynamics
Pharmacokinetics
Pharmacology/Toxicology
Pharmacotherapy
Physiology
Piperacillin
Pregnancy
Systematic Review
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Summary:Background and Objective Pharmacokinetics (PK) are severely altered in pregnant women due to changes in volume of distribution (Vd) and/or drug clearance (CL), affecting target attainment of antibiotics in pregnant women. This review is part of a series that reviews literature on the description of PK and target attainment of antibiotics in pregnant women with specific focus on penicillins. Methods A systematic literature search was carried out in PubMed. Articles were labelled as relevant when information on PK of penicillins in pregnant women was available. Results Thirty-two relevant articles were included, 8 of which discussed amoxicillin (with and without clavulanic acid), 15 ampicillin, 4 benzylpenicillin, 1 phenoxymethylpenicillin, and 4 piperacillin (with and without tazobactam). No studies were found on pheneticillin and flucloxacillin in pregnant women. Ten out of 32 articles included information on both Vd and CL. During the second and third trimester of pregnancy, a higher CL and larger Vd was reported than in non-pregnant women and in pregnant women during first trimester. Reduced target attainment was described in second and third trimester pregnant women. Only 7 studies reported dosing advice, 4 of which were for amoxicillin. Conclusion The larger Vd and higher CL in second and third trimester pregnant women might warrant a higher dosage or shortening of the dosing interval of penicillins to increase target attainment. Studies frequently fail to provide dosing advice for pregnant women, even if the necessary PK information was available.
Bibliography:content type line 23
SourceType-Scholarly Journals-1
ISSN:0312-5963
1179-1926
1179-1926
DOI:10.1007/s40262-023-01211-z