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Inhalative antibiotics during pregnancy

Question
Hello,
I am 30 years old and pregnant with my second child. During my first pregnancy I inhaled pulmozyme, aztreonam and hypertonic saline and did not think about it. I took the whole time cefuroxim as an oral antibiotic.
During this pregnancy I informed myself via the internet and found reports that dehorted the usage of pulmozyme and aztreonam during pregnancy, now I do not know, what to do. I stopped cefuroxim in august and I am quite doing well. Do I harm my child with the inhaled drugs?
My lung function value FEV1 is 84%. In my center I unfortunately get only insecure answers, as I would be the first pregnang woman for them.
Many thanks for your answer.
Answer
Dear questioner,
in the leaflet of the mentioned drugs you find the following information:
pulmozyme:
the harmlessness of pulmozyme during pregnancy is not proven. Experiments with animals do not show a direct or indirect negative effect on the pregnancy or the fetal developmeht. One should be carful with the usage of pulmozyme /rh-DNAse during pregnancy.
Concerning breast feading: in case of the inhalative usage of pulmozyme in the recommended dosage the systemic absorption of pulmozyme is little; therefore one assumes that no detectable concentrations of the drug reach the mother milk. Nevertheless one should be carfule in using pulmozyme/rh-DNAse in case of breast-feeding.

Aztreonam (Cayston):
Pregnancy: there is no data concerning the usage of aztreonam in case of pregnancy. Experiments with animals did not show direct or indirect harming effects concerning the reporduction toxicity.
The systemic concentration after inhalative usage of aztreonam is little. Cayston should not be used during pregnancy except the clinical status of the woman need a treatment with it.
Breast feeding: after usage of aztreonam for injection, it is only found in low concentration in the mother milk. After inhalation of Cyston, the systemic aztreonam concentration is about 1% of the concentration after usage via injection. Therefore, due to the low oral resorption, the dosage of aztreonam, that reaches the child when the mother uses inhalative Cayston, is probably very low. Cayston can be used during breast feeding.

Nebusal 7%
There is no information of the company concerning the usage during pregnancy or breast feeding.

Now for you:
Cayston and pulmozyme can only be used during pregnancy, after a strict indication being made. That means, if possible, you should not use this drugs during pregnancy. It has to be decided with your treating CF physician, if it is really necessary for you to use this drugs.
Cayston can be used (as a single one of the mentioned) unproblematically when doing breast feeding.
Hypertonic saline can be used during pregnancy after consulting your CF physician. When doing breast feeding, it has to be taken into account that probably little amounts reach the mother milk.
Best regards,
Dr. Christina Smazcny
24.10.2019