Pregnancy antibiotics

Penicillin desensitization is the most common drug desensitization protocol and is required for penicillin-allergic patients when penicillin is clearly the best treatment option, e.g., when syphilis is present in pregnancy. Protocols have been adapted to most antibiotics. Tables 51-5 and 51-6 describe procedures for oral and intravenous penicillin desensitization.25... 

Hydration and electrolyte balance, often with ORT, are the cornerstone of treatment. The specific circumstances that antibiotics should be considered include high fevers, bloody stools, symptoms longer than 1 week, pregnancy, infection with HIV, and other immunocompromised hosts. 

Christensen B. Which antibiotics are appropriate for treating bacteriuria in pregnancy. J Antimicrob Chemother 2000 46(Suppl Sl) 29—34. Finn SD. Acute uncomplicated urinary tract infections. Med Clin North Am 1997 81 719-729. 

Czeizel AE, Rockenbauer M, Olsen J, Sorensen HT A teratological study of aminoglycoside antibiotic treatment during pregnancy. Scand J Infect Dis 2000 32 309-313. 

Rifaximin appeared to be effective and safe in both adults and children. Not only do these data support the efficacy of a nonabsorbable antibiotic in the treatment of diarrhea, the lack of absorption and degree of safety reported to date support the likelihood that rifaximin will be safe to use in pregnant women. Currently, the drugs of choice for the treatment of bacterial diarrhea, especially travelers diarrhea, are the fluoroquinolones, which are contraindicated in pregnancy. While rifaximin will likely never be adequately studied in pregnancy, it should be safe. 

McDonald H, Brocklehurst P, Parsons J, Vig-neswaran R Antibiotics for treating bacterial vaginosis in pregnancy. Cochrane Database Syst Rev 2003 2 CD000262. 

Antibiotics are warranted in patients who present with high fevers, severe bloody diarrhea, prolonged illness (greater than 1 week), pregnancy, and immunocompromised states, including human immunodeficiency virus infection. 

Is treatment with an antibiotic necessary Symptomatic patients always need treatment. Asymptomatic bacteriuria (=10 bacteria/ml in two separate urine cultures) only needs treatment in pregnancy, in children and in obstructions of the urinary tract. Obstmctions in urinary flow must be treated before an antibiotic is started. There is no clear evidence that hydration or acidification of urine improves the results of antimicrobial therapy. 

Antibiotics also are active against other protozoans. Tetracycline and erythromycin are alternative therapies for the treatment of intestinal amebiasis. Clindamycin, in combination with other agents, is effective therapy for toxoplasmosis, pneumocystosis, and babesiosis. Spiramycin is a macrolide antibiotic that is used to treat primary toxoplasmosis acquired during pregnancy. Treatment lowers the risk of the development of congenital toxoplasmosis. 

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