Antimicrobials to be avoided or used with caution in pregnancy and breastfeeding

For complete list of non antimicrobial medicines see main Zimbabwe STG

Antimicrobials to be avoided/used with caution during breastfeeding

Medicine	Recommendations
Chloramphenicol	May cause bone marrow toxicity in infant
Doxycycline	Caution, although probably minimal levels in the milk
Sulphonamides	Caution – significant risk of kernicterus

Medicine	Trimester	Note	Recommendations
Albendazole	1	Avoid	Potentially teratogenic. Wait until after delivery
Albendazole	2 & 3	Caution	Potentially teratogenic. Wait until after delivery
Chloramphenicol	3	Caution	‘Grey baby syndrome’ avoid long courses
Ciprofloxacin	1	Avoid
Ciprofloxacin	2	Caution
Cotrimoxazole	All	Avoid	Risk of teratogenicity and methemoglobinemia
Doxycycline	All	Avoid	Dental discolouration, maternal hepatotoxicity with large doses
Gentamicin, Kanamycin, Amikacin (Aminoglycosides)	All	Avoid	May cause auditory or vestibular nerve damage, risk greatest with streptomycin and kanamycin, small with gentamicin.
Metronidazole	1	Avoid	Avoid high doses
Metronidazole	2 & 3	Caution	Avoid high doses
Praziquantel	1	Avoid	Wait
Pyrimethamine/Sulphadoxine	1	Avoid	Give with folic acid
Pyrimethamine/Sulphadoxine	2 & 3	Caution	Give with folic acid
Sulphonamides	3	Avoid	Risk of teratogenicity, methemoglobinemia, kernicterus
Streptomycin	All	Avoid	May cause auditory or vestibular nerve damage, risk greatest with streptomycin and kanamycin
Vaccines – live	All	Avoid