infection in pregnant patients
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Notes
A woman in the 3rd trimester of pregnancy is immunosuppressed.
- defects in neutrophil chemotaxis
- defects in delayed-type T-cell mediated immunity
Special considerations
- disseminated infection
- urinary tract infection are particularly common
- bacterial growth in urine is promoted by intermittent
- screen for asymptomatic bacteria monthly
- treat asymptomatic bacteria for 10-14 days
- asymptomatic urinary tract infections progress to pyelonephritis in 40% of pregnant women
- symptomatic urinary tract infections
- relapse or reinfect frequently
- treat aggressively with ampicillin or cephalosporin for 6 weeks
- pyelonephritis occurs in 1-2% of patients
- post-coital cystitis
- treat for 7 days, then once after each episode of intercourse
- if history of anaphylaxis with penicillin, treat with nitrofurantoin[7]
- treat for 7 days, then once after each episode of intercourse
- adequate to high fluid intake
- recurrent skin infections should prompt consideration of MRSA[2] - no evidence MRSA skin infection affects neonate
- Haemophilus influenzae more common in pregnant women & linked to adverse fetal outcomes
- relative risk = 13; absolute risk = 0.0005%[4]
Antibiotics generally contraindicated during pregnancy
- amantadine
- clarithromycin
- doxycycline
- flucytosine
- quinolones
- tetracycline
- bismuth subsalicylate (2nd half of pregnancy)
Antibiotics to be avoided if alternatives are available
- azole & triazole antifungal agents
- chloramphenicol at term
- metronidazole
- aminoglycosides
- antiparasitic agents
- antimalarial agents
- trimethoprim-sulfamethoxazole (Bactrim)
- most antiviral agents
Antibiotics generally regarded as safe during pregnancy
- beta-lactams
- erythromycin (except estolate)
- azithromycin
- safe in animal studies
- no studies in humans
- isoniazid
- amphotericin B
- mefloquine
also see medications during pregnancy
More general terms
More specific terms
References
- ↑ Medical Knowledge Self Assessment Program (MKSAP) 11, 18. American College of Physicians, Philadelphia 1998, 2018.
- ↑ 2.0 2.1 Laibl VR, Sheffield JS, Roberts S, McIntire DD, Trevino S, Wendel GD Jr. Clinical Presentation of Community-Acquired Methicillin- Resistant Staphylococcus aureus in Pregnancy. Obstet Gynecol. 2005 Sep;106(3):461-5. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16135574
- ↑ Prescriber's Letter 16(12): 2009 Antibiotic and Antifungal Use During Pregnancy and Breastfeeding Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=251206&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ 4.0 4.1 Collins S et al Risk of Invasive Haemophilus influenzae Infection During Pregnancy and Association With Adverse Fetal Outcomes. JAMA. 2014;311(11):1125-1132 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24643602 <Internet> http://jama.jamanetwork.com/article.aspx?articleid=1841966
Edwards MS Adverse Fetal Outcomes. Expanding the Role of Infection. JAMA. 2014;311(11):1115-1116 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24643600 <Internet> http://jama.jamanetwork.com/article.aspx?articleid=1841951 - ↑ Kourtis AP, Read JS, Jamieson DJ Pregnancy and Infection N Engl J Med 2014; 370:2211-2218. June 5, 2014 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24897084 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMra1213566
- ↑ Mehta N, Chen K, Hardy E, Powrie R. Respiratory disease in pregnancy. Best Pract Res Clin Obstet Gynaecol. 2015 Jul;29(5):598-611. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/25997564
- ↑ 7.0 7.1 7.2 NEJM Knowledge+