Gastro-intestinal absorption and transplacental transfer of amoxycillin during labour and the influence of metoclopramide

Abstract

The absorption of amoxycillin from the gastro-intestinal tract, with or without oral metoclopramide, has been evaluated. Levels of amoxycillin in the maternal blood and liquor prior to the induction of labour were of a therapeutic level against many organisms. However, absorption during labour, as reflected by maternal blood levels at delivery and cord blood levels, suggests that amoxycillin is poorly absorbed and may not reach adequate therapeutic levels in the fetus. Oral metoclopramide did not improve the absorption of amoxycillin. Should a parenteral form of amoxycillin become available, a similar study of blood and liquor levels may indicate that, like ampicillin, intramuscular administration is required for adequate therapeutic use at this stage of pregnancy. Until an oral formulation of an appropriate antibiotic is available which gives rapid absorption may and a sustained level of the chemotherapeutic agent in this situation, parenteral administration of an appropriate antibiotic remains mandatory.

Drugs, Diseases and Altered Gastric Emptying

“…Intramuscular metocJopramide (lOmg im) had no effect on the narcotic-induced delay in emptying rate. Amoxycillin absorption is also delayed and therapeutic plasma or amniotic fluid concentrations are not achieved during labour (Buckingham et al, 1975). Absorption was not improved by metoclopramide but no information was given about the administration of analgesics to the patients in this study.…”

Amoxicillin Pharmacokinetics in Pregnant Women: Modeling and Simulations of Dosage Strategies

“…One study reported amoxicillin serum concentrations during pregnancy 19 . This study offered limited data in that it examined amoxicillin pharmacokinetics only at the time of delivery, did not have a control group, and used a microbiologic assay for the measurement of serum amoxicillin concentrations.…”

Pharmacokinetics of β-Lactam Antibiotics

“…Oral absorption is unreliable during labor and does not improve with the concurrent intramuscular injection of metoclopramide (BUCKINGHAM et al 1975). Placental transfer appears to be slow, although concentrations in cord blood and amniotic fluid eventually surpass those in maternal serum (BERGOGNE-BEREZIN et al 1979 b).…”