In the postpartum period, the pharmacokinetics of antibiotics do not significantly change. In the early postpartum period there is an increase in the half-life of some antibacterial drugs, the volume of distribution and the renal clearance of these antibiotics are increased. In puerperas, antibiotics are found in uterine lochia and milk.
Antibacterial drugs for use in obstetric practice, as indicated above, should not have any teratogenic or embryotoxic properties; as far as possible, with maximum efficacy, be of low toxicity, with a minimum incidence of side effects. A number of modern antibiotics fully meet these requirements, in particular, inhibitor-protected penicillins, cephalosporins and macrolides. As you know, penicillins penetrate the placenta, but they are quite safe. There is a fairly large amount of observation in pregnant women who received them in the first trimester, but even in this case there were no serious anomalies, this group of drugs can be used in the postpartum period without stopping breastfeeding. Cephalosporins easily cross the placenta, so their use in the first trimester is still not recommended. The conducted preclinical studies did not reveal any mutagenic or teratogenic effect in the preparations of these groups.
Due to the wide range of pathogens that cause inflammation in the female genital organs, the choice of an effective antibiotic is crucial. Treatment in many cases is carried out with a combination of broad-spectrum drugs, preferably intracellularly penetrating, and anti-anaerobic drugs.
Dosage forms and pharmacokinetic properties of antimicrobial drugs allow you to use the principle of “step therapy”, that is, to begin the course with parenteral administration of drugs, and finish taking the tablets of the antibiotic.