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Sulfonamides and Nitrofurantoins OK to Use During Pregnancy
May 31, 2011 — During the second and third trimester of pregnancy, sulfonamides and nitrofurantoins may be used as first-line agents for urinary tract and other infections, but in the first trimester, these agents may be used when no alternatives are available, according to a Committee Opinion from the American College of Obstetricians and Gynecologists (ACOG).
The opinion is published in the June issue of Obstetrics & Gynecology. According to the study authors, a 2009 case-control study of data from the National Birth Defects Prevention Study found that nitrofurans and sulfonamides were significantly associated with multiple birth defects, whereas penicillins, erythromycin, cephalosporins, and the quinolones were not.
However, the authors acknowledge several limitations of the 2009 study. In addition, they note that "other studies have not found such risks among other populations or when using different epidemiologic methods."
According to the authors, antibiotics "should be prescribed for pregnant women only for appropriate indications and for the shortest effective duration."
They add that many urine cultures show bacterial contaminants that do not represent true infection. However, when selecting an antibiotic for a true infection during the first trimester, "health care providers should consider and discuss with patients the benefits as well as the potential unknown risks of teratogenesis and maternal adverse reactions."
They suggest that prescribing sulfonamides or nitrofurantoins in the first trimester is still considered appropriate when no other suitable alternative antibiotics are available.
"During the second and third trimesters, sulfonamides and nitrofurantoins may continue to be used as first-line agents for the treatment and prevention of urinary tract infections and other infections caused by susceptible organisms," they write.
They also caution that "pregnant women should not be denied appropriate treatment for infections because untreated infections can commonly lead to serious maternal and fetal complications."Obstet Gynecol. 2011;117:1484-1485. Abstract 2011年-5月31日--根据来自美国妇产科医生大学（ACOG)委员会的意见,在第二孕期和第三孕期间,磺胺类药物和呋喃妥因可作为泌尿系统和其它感染性疾病的一线药物,但在第一孕期时,这些药物用于当没有替代药物可得到时. 这个观点刊在妇产科学杂志6月刊上。据这项研究的作者所说,一个2009的病例对照研究的数据，来自于国家新生儿缺陷预防研究，发现呋喃妥因和磺胺类药物与多个出生缺陷有显著相关,而青霉素、红霉素、头孢菌素、喹诺酮类是无显著相关的。 然而,作者承认了2009年的研究一些局限性。而且,他们指出“在其他人群或当使用不同的流行病学方法的其他的研究没有发现这样的危险。” 作者认为,抗生素"应该是开具给有适当适应症的怀孕妇女，并给以最短的有效疗程。” 他们补充说,许多尿培养属细菌污染,不代表真正的感染。然而,当在第一孕期时为真正的感染选择抗菌药物时，“除了潜在的未知的致畸风险和母亲的不良反应外，医务人员与病人应考虑并讨论使用抗菌药物带来的益处。” 他们建议在第一孕期时，磺胺类药物或呋喃妥因在没有其他合适的可替代药物的情况下使用仍被认为是适当的。
“在第二和第三孕期,磺胺类药物和呋喃妥因可继续作为一线药物来治疗和预防敏感菌引起的泌尿道感染和其他的感染，”他们写到。 他们还警告说,“孕妇不应拒绝适当的感染治疗，因为未经处理的感染通常可导致严重的母婴并发症。”
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