Medications for Pregnant Travelers

It is not our aim in this chapter to discus all the medicines you might consider using during your pregnancy.  In fact, most of the medicines prescribed during pregnancy for travel-related illnesses are discussed in other chapters.  We refer you to the chapters on diarrhea, malaria prevention, the medical kit and so forth.

Here, we would just like to mention some general principles regarding medication in pregnancy.  There are a few specific medicines that need to be mentioned and we will refer you to sources where you can get more information.

When it comes to shots and medications, in our clinic we try to adhere to two general principles.

The first is the principle of avoidance.  If you can safely avoid using a particular medicine or getting a vaccine, you should do so. 

Sometimes a simple change of itinerary will accomplish this.  For instance, if visiting a country where there is malaria you may be able to avoid the parts of the country where this is a problem.  Or staying indoors in the evening and living only in lodgings where there are screens on the windows and mosquito nets on the beds may sufficiently reduce your exposure.

The second principle is that of comparative risk.

Remember that, despite some theoretical risks, there are very few medicines and no currently available vaccines that are of proven risk to a developing fetus.  On the other hand, many of the diseases we are trying to prevent are clearly harmful to the fetus and may even cause its death.  Therefore, if there is no way to avoid exposure to a given disease, then the medicine is definitely the lesser of two evils.  What I often tell my patients is, “I cannot guarantee that this medicine will not hurt your baby.  But I can promise you that if you don’t take it, that will hurt your baby.”

Another thing to remember is that the medicines that are considered the best for a certain condition in your home country may not even be available in your destination country.  Some antibiotics, for instance, are of dubious safety in pregnancy.  But in a developing country the newer, safer medicines may not be available.  Once again, the principle of comparative risk applies.  A drug that may cause harm is better than a disease that definitely will cause harm.  This is one more reason, though, to get careful counseling before you go and to take an adequate supply of medicine with you.

Some of those medicines that should be avoided during pregnancy, if possible, include antibiotics like tetracycline, doxycycline, streptomycin and chloramphenicol.  Antibiotics generally considered safe in pregnancy include penicillin, ampicillin, cephalexin, erythromycin, azithromycin, aztreonam, nitrofurantoin, nystatin and nalidixic acid.

The antimalarials are discussed in a separate chapter, as are medicines for diarrhea.

If questions come up regarding a particular medicine, we recommend your doctor consult the book, “Drugs in Pregnancy and Lactation” by Drs. Briggs, Freeman and Yaffe.  A couple of helpful web sites are Reproductive Toxicology (http://reprotox.org/) and Clinical NetwoRx  (http://www.cnrx.com/).