OBJECTIVE: To review the safety and pharmacokinetics of antimicrobials recommended for anthrax postexposure prophylaxis and treatment in pregnant women. DATA SOURCES: Articles were identified in the PubMed database from inception through December 2012 by searching the keywords (["pregnancy]" and [generic antibiotic drug name]). Additionally, we searched clinicaltrials.gov and conducted hand searches of references from REPROTOX, TERIS, review articles, and Briggs' Drugs in Pregnancy and Lactation. METHODS OF STUDY SELECTION: Articles included in the review contain primary data related to the safety and pharmacokinetics among pregnant women of 14 antimicrobials recommended for anthrax postexposure prophylaxis and treatment (amoxicillin, ampicillin, chloramphenicol, clindamycin, ciprofloxacin, doripenem, doxycycline, levofloxacin, linezolid, meropenem, moxifloxacin, penicillin, rifampin, and vancomycin). TABULATION, INTEGRATION, AND RESULTS: The PubMed search identified 3,850 articles for review. Reference hand searching yielded nine additional articles. In total, 112 articles met the inclusion criteria. CONCLUSIONS: Overall, safety and pharmacokinetic information is limited for these antimicrobials. Although small increases in risks for certain anomalies have been observed with some antimicrobials recommended for prophylaxis and treatment of anthrax, the absolute risk of these antimicrobials appears low. Given the high morbidity and mortality associated with anthrax, antimicrobials should be dosed appropriately to ensure that antibiotic levels can be achieved and sustained. Dosing adjustments may be necessary for the beta-lactam antimicrobials and the fluoroquinolones to achieve therapeutic levels in pregnant women. Data indicate that the beta-lactam antimicrobials, the fluoroquinolones, and, to a lesser extent, clindamycin enter the fetal compartment, an important consideration in the treatment of anthrax, because these antimicrobials may provide additional fetal benefit in the second and third trimesters of pregnancy.

OBJECTIVE: To describe the worldwide experience of Bacillus anthracis infection reported in pregnant, postpartum, and lactating women. DATA SOURCES: Studies were identified through MEDLINE, Web of Science, Embase, and Global Health databases from inception until May 2012. The key words (["anthrax" or "anthracis"] and ["pregna*" or "matern*" or "postpartum" or "puerperal" or "lact*" or "breastfed*" or "breastfeed*" or "fetal" or "fetus" or "neonate" or "newborn" or "abort*" or "uterus"]) were used. Additionally, all references from selected articles were reviewed, hand searches were conducted, and relevant authors were contacted. METHODS OF STUDY SELECTION: The inclusion criteria were: published articles referring to women diagnosed with an infection due to exposure to B anthracis during pregnancy, the postpartum period, or during lactation; any article type reporting patient-specific data; articles in any language; and nonduplicate cases. Non-English articles were professionally translated. Duplicate reports, unpublished reports, and review articles depicting previously identified cases were excluded. TABULATION, INTEGRATION, AND RESULTS: Two authors independently reviewed articles for inclusion. The primary search of the four databases yielded 1,340 articles, and the secondary crossreference search revealed 146 articles. Fourteen articles met the inclusion criteria. In total, 20 cases of B anthracis infection were found, 17 in pregnant women, two in postpartum women, and one case in a lactating woman. Among these reports, 16 women died and 12 fetal or neonatal losses were reported. Of these fatal cases, most predated the advent of antibiotics. CONCLUSIONS: Based on these case reports, B anthracis infection in pregnant and postpartum women is associated with high rates of maternal and fetal death. Evidence of possible maternal-fetal transmission of B anthracis infection was identified in early case reports.