Systemic candidiasis

January 2005     View PDF     En español

Anti-fungal drugs and pregnancy

The Federal Guidelines for the Prevention of Opportunistic Infections include recommendations about using antifungal drugs during pregnancy. In short, they recommend that oral azole drugs (including fluconazole, itraconazole and ketoconazole) not be started during pregnancy. The Guidelines further state that azoles be stopped in women who become pregnant and that women taking these drugs use effective birth control.

In animal studies, using itraconazole or ketoconazole during pregnancy caused birth defects. There have also been four known infants born with severe skeletal problems to women who used fluconazole for an extended time while pregnant. It’s presumed that these same risks apply to other oral azole drugs.

For treating or preventing oral or vaginal candidiasis, topical therapies like nystatin (Mycostatin, Pedi-Dri) may be preferable for pregnant women. For treating or preventing other fungal infections, like histoplasmosis, the Guidelines suggest amphotericin B, especially in the first trimester. It is also approved for treating thrush.

Although no formal studies have been performed, pregnant women have used amphotericin B without apparent harm to their unborn children. While amphotericin B may be preferable to azole therapy in pregnant women, it has possible severe side effects, including kidney toxicity and anemia.