Antibiotics in pregnancy: important new guidelines

Antibiotics in pregnancy: important new guidelines

May 8, 2017

Public Health England has issued revised guidance for primary care practitioners on the management of infections in pregnancy following the publication of new evidence of increased risk of spontaneous abortion.

Read the new guidance here.

Find out more about the newly-published research [Flory T.M., Sheehy O., Berard A. (2017) ‘Use of antibiotics during pregnancy and risk of spontaneous abortion’, CMAJ, 189(17), 1 May]

Key changes:

PHE have reviewed the new evidence and updated the guidelines (04.05.2017) to include:

Page 5
13. In pregnancy, take specimens to inform treatment, use this guidance alternative or seek expert advice. Penicillins, cephalosporins and erythromycin are not associated with increased risks. If possible, avoid tetracyclines, quinolones, aminoglycosides, azithromycin, clarithromycin, high dose metronidazole (2g stat) unless the benefits outweigh the risks. Short-term use of nitrofurantoin is not expected to cause foetal problems (theoretical risk of neonatal haemolysis). Trimethoprim is also unlikely to cause problems unless poor dietary folate intake, or taking another folate antagonist

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Acute sore throat
Pregnant & penicillin allergy: erythromycin

Page 17
12.Flory TM, Sheehy O, Berard A. Use of antibiotics during pregnancy and risk of spontaneous abortion. CMAJ. 2017 May; 1(189):625-633. Available from: RATIONALE: A nested case-control study within the Quebec Pregnancy Cohort between 1998 and 2009, aiming to quantify the association between antibiotic exposure during pregnancy and risk of spontaneous abortion. Spontaneous abortion was defined as having a diagnosis or procedure related to spontaneous abortion before the 20th week of pregnancy. Use of antibiotics was defined by filled prescriptions between the first day of gestation and the index date. Results indicated that azithromycin (OR 1.65; 95% CI 1.34 to 2.02), clarithromycin (OR 2.35; 95% CI 1.90 to 2.91), metronidazole (OR 1.70; 95% CI 1.27 to 2.26), sulphonamides (OR 2.01; 95% CI 1.36 to 2.97), and tetracyclines (OR 2.59; 95% CI 1.97 to 3.41) were associated with an increased risk of spontaneous abortion. The authors conclude that the use of macrolides (excluding erythromycin), quinolones, tetracyclines, sulphonamides, and metronidazole should be avoided during early pregnancy due to the increased risk of spontaneous abortion. Erythromycin may be used as an alternative for pregnant women

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