Antiinfective therapy for pregnant or lactating patients in the emergency department

Harbison, Ashley F; Polly, Derek M.; Musselman, Megan E.

doi:10.2146/ajhp130797

Cited by 11 publications

(12 citation statements)

References 22 publications

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“…It must also be acknowledged that, while the overuse of antibiotics can promote antimicrobial resistance and microbiome dysbiosis, untreated infections can also be harmful, especially to a developing fetus. For example, urinary tract infections during pregnancy are associated with intrauterine growth restriction, preterm labour and miscarriage [40,41]. Keeping this risk-benefit balance in mind, it is important to study and clarify the potentially unintended consequences of prenatal antibiotic exposure.…”

Section: Discussionmentioning

confidence: 99%

Prenatal antibiotic exposure and childhood asthma: a population-based study

et al. 2018

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Antibiotic use during infancy alters gut microbiota and immune development and is associated with an increased risk of childhood asthma. The impact of prenatal antibiotic exposure is unclear. We sought to characterise the association between prenatal antibiotic exposure and childhood asthma.We performed a population-based cohort study using prescription records, hospitalisation records and physician billing claims from 213 661 mother-child dyads born in Manitoba, Canada between 1996 and 2012. Associations were determined using Cox regression, adjusting for maternal asthma, postnatal antibiotics and other potential confounders. Sensitivity analyses evaluated maternal antibiotic use before and after pregnancy.36.8% of children were exposed prenatally to antibiotics and 10.1% developed asthma. Prenatal antibiotic exposure was associated with an increased risk of asthma (adjusted hazard ratio (aHR) 1.23, 95% CI 1.20-1.27). There was an apparent dose response (aHR 1.15, 95% CI 1.11-1.18 for one course; aHR 1.26, 95% CI 1.21-1.32 for two courses; and aHR 1.51, 95% CI 1.44-1.59 for three or more courses). Maternal antibiotic use during 9 months before pregnancy (aHR 1.27, 95% CI 1.24-1.31) and 9 months postpartum (aHR 1.32, 95% CI 1.28-1.36) were similarly associated with asthma.Prenatal antibiotic exposure was associated with a dose-dependent increase in asthma risk. However, similar associations were observed for maternal antibiotic use before and after pregnancy, suggesting the association is either not directly causal, or not specific to pregnancy.

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Section: Discussionmentioning

confidence: 99%

Prenatal antibiotic exposure and childhood asthma: a population-based study

et al. 2018

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“…The most common infections encountered during pregnancy include urinary tract infections (UTIs), including pyelonephritis; sexually transmitted infections (STIs); and upper respiratory tract infections (URTIs) . Although use of any medication during pregnancy is a risk‐versus‐benefit decision, untreated infections such as UTIs or STIs are associated with significant fetal risk including spontaneous abortion, prematurity, and low birth weight . Safety and efficacy information are not usually available from randomized controlled trials, as these studies are often not feasible in pregnant women and are potentially unethical.…”

Section: Food and Drug Administration Pregnancy Category Ratings Withmentioning

confidence: 99%

“…Protein binding ranges from 20% to 50% . Fluoroquinolones may be safe during the first trimester but are not recommended, as they were associated with fetal harm in previous animal studies There is a suggested association with fluoroquinolones and renal toxicity, cardiac defects, and central nervous system toxicity in the fetus . Animal data have demonstrated bone and cartilage damage in the fetus .…”

Section: Fluoroquinolonesmentioning

confidence: 99%

“…1 Although use of any medication during pregnancy is a risk-versus-benefit decision, untreated infections such as UTIs or STIs are associated with significant fetal risk including spontaneous abortion, prematurity, and low birth weight. 4,5 Safety and efficacy information are not usually available from randomized controlled trials, as these studies are often not feasible in pregnant women and are potentially unethical. Thus, pregnancy is often a standard criterion for exclusion from clinical trials.…”

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confidence: 99%

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A Review of Antibiotic Use in Pregnancy

Bland²,

et al. 2015

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During pregnancy, untreated sexually transmitted or urinary tract infections are associated with significant morbidity, including low birth weight, preterm birth, and spontaneous abortion. Approximately one in four women will be prescribed an antibiotic during pregnancy, accounting for nearly 80% of prescription medications in pregnant women. Antibiotic exposures during pregnancy have been associated with both short-term (e.g., congenital abnormalities) and long-term effects (e.g., changes in gut microbiome, asthma, atopic dermatitis) in the newborn. However, it is estimated that only 10% of medications have sufficient data related to safe and effective use in pregnancy. Antibiotics such as beta-lactams, vancomycin, nitrofurantoin, metronidazole, clindamycin, and fosfomycin are generally considered safe and effective in pregnancy. Fluoroquinolones and tetracyclines are generally avoided in pregnancy. Physiologic changes in pregnancy lead to an increase in glomerular filtration rate, increase in total body volume, and enhanced cardiac output. These changes may lead to pharmacokinetic alterations in antibiotics that require dose adjustment or careful monitoring and assessment.

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“…It is anticipated that up to 30% of women will receive a course of antibiotics during pregnancy for a confirmed or presumed bacterial infection, most commonly UTIs, URTIs, or STIs. [94][95][96][97] CPGs, if available, often include limited sections on management of bacterial infections in pregnancy. This review provides the clinician with a resource for management of common viral and bacterial infections in pregnancy for both patient care decision making and trainee instruction.…”

Section: Relevance To Patient Care and Clinical Practicementioning

confidence: 99%

Common Bacterial and Viral Infections: Review of Management in the Pregnant Patient

et al. 2018

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Objective: To review the treatment of common bacterial and viral infections occurring in the pregnant patient. Data Sources: A literature search of MEDLINE was performed (inception to October 2018). The Centers for Disease Control and Prevention website was utilized for additional information. Study Selection and Data Extraction: Relevant English-language studies and those conducted in humans were considered. Data Synthesis: β-Lactams alone or in combination are the preferred treatment for many common infections in pregnancy, such as urinary tract infections, pelvic inflammatory disease (PID), gonococcal infections, syphilis, chancroid, upper- and lower-respiratory-tract infections, certain gastrointestinal infections, Group B Streptococcus, listeriosis, and intrauterine inflammation or infection. Macrolides, particularly azithromycin, are also utilized for the treatment of PID, chlamydia, gonococcal infections, chancroid, community-acquired pneumonia, and certain gastrointestinal infections. Other antibiotics or antivirals such as vancomycin, aminoglycosides, metronidazole, nitrofurantoin, fosfomycin, acyclovir, valacyclovir, and oseltamivir are included in the preferred therapy for some common bacterial and viral infections in pregnant patients as well. Relevance to Patient Care and Clinical Practice: This review synthesizes available evidence of treatments of common infections in pregnancy and provides a concise summary to guide clinicians on empirical treatment during pregnancy. Conclusions: There are limited data on clinical outcomes in pregnant patients with common bacterial and viral infections. Empirical management decisions require balance of benefit and risk to both mother and infant. Although few clinical practice guidelines have quality evidence for strong recommendations in this population, clinicians should weigh antimicrobial dosing, pharmacokinetics, safety, and established effectiveness to optimize antimicrobial therapy in pregnancy.

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Antiinfective therapy for pregnant or lactating patients in the emergency department

Abstract: The use of antiinfective agents in pregnant or lactating women requires consideration not only of the drugs' effectiveness but also their possible effects on the fetus or newborn and the nature of follow-up care. References are available to help clinicians make treatment decisions.

Cited by 11 publications

References 22 publications

Prenatal antibiotic exposure and childhood asthma: a population-based study

Prenatal antibiotic exposure and childhood asthma: a population-based study

A Review of Antibiotic Use in Pregnancy

Common Bacterial and Viral Infections: Review of Management in the Pregnant Patient

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