Safety of Cotrimoxazole in Pregnancy

Abstract

Introduction Cotrimoxazole is widely prescribed to treat a range of infections and for HIV-infected individuals it is administered as prophylaxis to protect against opportunistic infections. Some reports suggest that fetuses exposed to cotrimoxazole during early pregnancy may have an increased risk of congenital anomalies. We carried out this systematic review in order to update the evidence of cotrimoxazole safety in pregnancy. Methods Three databases and one conference abstract site were searched in duplicate up to 31 October, 2013 for studies reporting adverse maternal and infant outcomes among women receiving cotrimoxazole during pregnancy. This search was updated in MEDLINE via PUBMED to 28 April 2014. Studies were included irrespective of HIV-infection status or the presence of other co-infections. Our primary outcome was birth defects of any kind. Secondary outcomes included spontaneous abortions, terminations of pregnancy, stillbirths, preterm deliveries, and drug-associated toxicity. Results 24 studies were included for review. There were 232 infants with congenital anomalies among 4196 women receiving cotrimoxazole during pregnancy, giving an overall pooled prevalence of 3.5% (95% CI 1.8–5.1%; τ2 0.03). Three studies reported 31 infants with neural tube defects, giving a crude prevalence of 0.7% (95%CI 0.5–1.0%) with most data (29 neural tube defects) coming from a single study. The majority of adverse drug reactions were mild. The quality of the evidence was very low. Conclusions The findings of this review support continued recommendations for cotrimoxazole as a priority intervention for HIV-infected pregnant women. It is critical to improve data collection on maternal and infant outcomes.

Prevalence of vulvovaginal candidiasis in gynecological practices in Germany: A retrospective study of 954,186 patients

“…The recent guidelines of the German Society of Gynecology and Obstetrics indicate that the treatment of VVC with the antimycotic agents available on the market is successful in most cases, and that polyenes such as nystatin or amphotericin B, imidazoles such as clotrimazole or miconazole, and oral triazoles such as fluconazole or itraconazole, are equally effective [ 8 ]. Cotrimoxazole (trimethoprim-sulfamethoxazole) was the most frequently prescribed drug, a finding that might be explained by the fact that it is a safe, effective, low-cost combination antibiotic prescribed for the treatment of a wide range of bacterial, parasitic, and fungal infections [ 22 ].…”

Microbial Profile and Antimicrobial Susceptibility of Bacteria Found in Inflammatory Hidradenitis Suppurativa Lesions

“…Second, besides a broad-spectrum activity our findings revealed that cotrimoxazole had a low resistance rate of 13%. Third, increasing evidence from antibiotic prophylaxis with cotrimoxazole in HIV-infected adults and children showed that long-term therapy is safe and inexpensive [35,36,37]. Fourth, there is also strong evidence showing that, in addition to its antimicrobial properties, cotrimoxazole also has immunomodulatory and anti-inflammatory effects.…”

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“…Some studies have reported potential risks of abortion and physical deformation of the foetus in the first semester of the pregnancy ( Richardson et al., 2000 ; Czeizel et al., 2001 ; Straub 2016 ). Other studies have reported that the risk of birth defects and malformation of the foetus in pregnant women is low and that the benefit of the medication outweighs its potential health risks ( Ford et al., 2014 ).…”