CAPREOMYCIN

Fetal Risk Summary

Capreomycin is a polypeptide antibiotic isolated from Streptomyces capreolus. The antibiotic is a mixture of four active components consisting of capreomycin IA and IB (combined total at least 90% of the product), and capreomycin IIA and IIB. Capreomycin is given by IM injection. Less than 1% is absorbed orally. It is indicated, in combination with other antituberculosis agents, as an alternate drug when the primary agents are ineffective or cannot be used because of toxicity. Because the toxicity of capreomycin is similar to aminoglycosides (e.g., cranial nerve VIII and renal), it should not be used with these agents.

Capreomycin caused a low incidence of wavy ribs in rats given doses 3.5 times the human dose (1). No studies have been conducted on the effects of the antibiotic on fertility, carcinogenicity, or mutagenicity (1).

No reports describing the use of capreomycin during human pregnancy have been located. A 1992 review of tuberculosis and pregnancy stated that the safety of capreomycin in pregnancy was not established, but cited no References of its use (2). Two other sources, one published in 1995 and the other in 1996, concluded that capreomycin should be avoided, if possible, because of the potential for ototoxicity and deafness (3,4). Neither source cited pregnancy data involving capreomycin.

Breast Feeding Summary

It is not known if capreomycin is excreted into breast milk. No reports describing the use of capreomycin in lactation have been located. Because most antibiotics are excreted, however, the presence of the antibiotic in milk should be assumed. The effects on a nursing infant from this exposure are unknown. However, less than 1% of an oral dose is absorbed systemically, so the risk, if any, to a nursing infant appears to be minimal.

References

1. Product information. Capastat. 1990.
2. Hamadeh MA, Glassroth J. Tuberculosis and pregnancy. Chest 1992;101:1114–20.
3. Davidson PT. Managing tuberculosis during pregnancy. Lancet 1995;346:199–200.
4. Robinson CA, Rose NC. Tuberculosis: current implications and management in obstetrics. Obstet Gynecol Surv 1996;51:115–24.