title: Antifungal drugs during pregnancy: an updated review.
abstract: Antifungal prescription remains a challenge in pregnant women because of uncertainties regarding fetal toxicity and altered maternal pharmacokinetic parameters that may affect efficacy or increase maternal and fetal toxicity. We present updated data reviewing the available knowledge and current recommendations regarding antifungal prescription in pregnancy. Amphotericin B remains the first-choice parenteral drug in spite of its well-established toxicity. Topical drugs are used throughout pregnancy because of limited absorption. Recent data have clarified the teratogenic effect of high-dose fluconazole during the first trimester and provided reassuring cumulative data regarding its use at a single low dose in this key period. Recent data have also provided additional safety data on itraconazole and lipidic derivatives of amphotericin B. Regarding newer antifungal drugs, including posaconazole and echinocandins, clinical data are critically needed before considering prescription in pregnancy.
authors.affiliation: Infectious Diseases Department, Université Paris Descartes, Sorbonne Paris Cité, Centre d'Infectiologie Necker-Pasteur, Hôpital Necker-Enfants Malades, Paris, France.
authors.forename: Benoît
authors.initials: B
authors.lastname: Pilmis
authors.affiliation: Pharmacology Department, Université Paris Descartes, Sorbonne Paris Cité, Inserm U1129, Hôpital Européen Georges-Pompidou, Paris, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Jullien
authors.affiliation: Wayne State University, Detroit, MI, USA.
authors.forename: Jack
authors.initials: J
authors.lastname: Sobel
authors.affiliation: Infectious Diseases Department, Université Paris Descartes, Sorbonne Paris Cité, Centre d'Infectiologie Necker-Pasteur, Hôpital Necker-Enfants Malades, Paris, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Lecuit
authors.affiliation: Infectious Diseases Department, Université Paris Descartes, Sorbonne Paris Cité, Centre d'Infectiologie Necker-Pasteur, Hôpital Necker-Enfants Malades, Paris, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Lortholary
authors.affiliation: Infectious Diseases Department, Université Paris Descartes, Sorbonne Paris Cité, Centre d'Infectiologie Necker-Pasteur, Hôpital Necker-Enfants Malades, Paris, France caroline.charlier@nck.aphp.fr.
authors.forename: Caroline
authors.initials: C
authors.lastname: Charlier
mesh_terms: D061605:Administration, Intravenous; D000287:Administration, Topical; D000666:Amphotericin B / Q000009:adverse effects / Q000627:therapeutic use; D000891:Anti-Infective Agents, Local / Q000627:therapeutic use; D000935:Antifungal Agents / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D005260:Female; D015725:Fluconazole / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D017964:Itraconazole / Q000009:adverse effects / Q000627:therapeutic use; D009181:Mycoses / Q000188:drug therapy*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy*; D013723:Teratogens
chemical_list: D000891:Anti-Infective Agents, Local; D000935:Antifungal Agents; D013723:Teratogens; D017964:Itraconazole; D000666:Amphotericin B; D015725:Fluconazole
keywords: antifungal therapy; fetus; fungal infections; placenta