{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,7]],"date-time":"2026-11-07T10:32:15Z","timestamp":1794047535516,"version":"4.8.0"},"reference-count":197,"publisher":"Oxford University Press (OUP)","issue":"Supplement_1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,5,21]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The safety profile of antimicrobials used during pregnancy is one important consideration in the decision on how to treat and provide postexposure prophylaxis (PEP) for plague during pregnancy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We searched 5 scientific literature databases for primary sources on the safety of 9 antimicrobials considered for plague during pregnancy (amikacin, gentamicin, plazomicin, streptomycin, tobramycin, chloramphenicol, doxycycline, sulfadiazine, and trimethoprim-sulfamethoxazole [TMP-SMX]) and abstracted data on maternal, pregnancy, and fetal\/neonatal outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 13\u2005052 articles identified, 66 studies (case-control, case series, cohort, and randomized studies) and 96 case reports were included, totaling 27\u2005751 prenatal exposures to amikacin (n\u2005=\u20059), gentamicin (n\u2005=\u2005345), plazomicin (n\u2005=\u20050), streptomycin (n\u2005=\u2005285), tobramycin (n\u2005=\u200543), chloramphenicol (n\u2005=\u2005246), doxycycline (n\u2005=\u20052351), sulfadiazine (n\u2005=\u2005870), and TMP-SMX (n\u2005=\u200523\u2005602). Hearing or vestibular deficits were reported in 18\/121 (15%) children and 17\/109 (16%) pregnant women following prenatal streptomycin exposure. First trimester chloramphenicol exposure was associated with an elevated risk of an undescended testis (odds ratio [OR] 5.9, 95% confidence interval [CI] 1.2\u201328.7). Doxycycline was associated with cardiovascular malformations (OR 2.4, 95% CI 1.2\u20134.7) in 1 study and spontaneous abortion (OR 2.8, 95% CI 1.9\u20134.1) in a separate study. First trimester exposure to TMP-SMX was associated with increased risk of neural tube defects (pooled OR 2.5, 95% CI 1.4\u20134.3), spontaneous abortion (OR 3.5, 95% CI 2.3\u20135.6), preterm birth (OR 1.5, 95% CI 1.1\u20132.1), and small for gestational age (OR 1.6, 95% CI 1.2\u20132.2). No other statistically significant associations were reported.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>For most antimicrobials reviewed, adverse maternal\/fetal\/neonatal outcomes were not observed consistently. Prenatal exposure to streptomycin and TMP-SMX was associated with select birth defects in some studies. Based on limited data, chloramphenicol and doxycycline may be associated with adverse pregnancy or neonatal outcomes; however, more data are needed to confirm these associations. Antimicrobials should be used for treatment and PEP of plague during pregnancy; the choice of antimicrobials may be influenced by these data as well as information about the risks of plague during pregnancy.<\/jats:p><\/jats:sec>","DOI":"10.1093\/cid\/ciz1231","type":"journal-article","created":{"date-parts":[[2020,1,3]],"date-time":"2020-01-03T20:19:43Z","timestamp":1578082783000},"page":"S37-S50","source":"Crossref","is-referenced-by-count":43,"title":["Safety of Antimicrobials During Pregnancy: A Systematic Review of Antimicrobials Considered for Treatment and Postexposure Prophylaxis of Plague"],"prefix":"10.1093","volume":"70","author":[{"given":"Patricia A","family":"Yu","sequence":"first","affiliation":[{"name":"Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emmy L","family":"Tran","sequence":"first","affiliation":[{"name":"Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta, Georgia, USA"},{"name":"Eagle Global Scientific, LLC, San Antonio, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Corinne M","family":"Parker","sequence":"first","affiliation":[{"name":"Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA"},{"name":"Chenega Professional and Technical Services, LLC, Atlanta, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hye-Joo","family":"Kim","sequence":"first","affiliation":[{"name":"Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA"},{"name":"Chenega Professional and Technical Services, LLC, Atlanta, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eileen L","family":"Yee","sequence":"first","affiliation":[{"name":"Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA"},{"name":"Chenega Professional and Technical Services, LLC, Atlanta, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul W","family":"Smith","sequence":"first","affiliation":[{"name":"NCEZID, CDC, Atlanta, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zachary","family":"Russell","sequence":"first","affiliation":[{"name":"Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA"},{"name":"Oak Ridge Institute for Science and Education CDC Fellowship Program, Atlanta, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina A","family":"Nelson","sequence":"first","affiliation":[{"name":"Division of Vector-Borne Diseases, NCEZID, CDC, Fort Collins, Colorado, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cheryl S","family":"Broussard","sequence":"first","affiliation":[{"name":"Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yon C","family":"Yu","sequence":"first","affiliation":[{"name":"Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dana","family":"Meaney-Delman","sequence":"first","affiliation":[{"name":"Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2020,5,21]]},"reference":[{"key":"2020052103181039200_CIT0001","volume-title":"Plague and the end of antiquity: the pandemic of 541\u2013750","author":"Little","year":"2008"},{"key":"2020052103181039200_CIT0002","volume-title":"The black death 1346\u20131353: the complete history","author":"Benedictow","year":"2004"},{"key":"2020052103181039200_CIT0003","first-page":"1","article-title":"Plague: a new old disease","volume":"1","author":"Santana","year":"2016","journal-title":"Journal of Epidemiology and Public Health 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