Physicians commonly prescribe risky antibiotics for UTIs during early pregnancy

Despite warnings, physicians commonly prescribe risky antibiotics for urinary tract infections to women during early pregnancy, according to a new report.

Writing in MMWR, Elizabeth C. Ailes, PhD, from the CDC’s Division of Congenital and Developmental Disorders, and colleagues said nitrofurantoin and trimethoprim-sulfamethoxazole are still commonly prescribed and dispensed to women with UTIs during their first trimester of pregnancy.

According to Ailes and colleagues, UTIs occur in about 8% of pregnant women and can cause serious complications for mothers and their babies. The Infectious Diseases Society of America recommends nitrofurantoin and trimethoprim-sulfamethoxazole for nonpregnant women with uncomplicated UTIs, but because of the potential risk for birth defects, the American College of Obstetricians and Gynecologists said in 2011 that sulfonamides — for example, trimethoprim-sulfamethoxazole — and nitrofurantoin should be prescribed for pregnant women in their first trimester “only when other antimicrobial therapies are deemed clinically inappropriate,” Ailes and colleagues wrote.

The researchers examined data collected by Atlanta-based Truven Health Analytics to assesses the effect of the recommendations. Their analysis included 34,864 women aged between 15 and 44 years who were pregnant in 2014 and who were diagnosed with a UTI from 90 days before their last menstrual period (LMP) through the end of pregnancy, including 41% who were received their diagnosis in their first trimester.

Among pregnant women with a UTI, 68.9% were prescribed an antibiotic within 7 days compared with 76.1% of women who were diagnosed before their pregnancy and filled their prescriptions during the 90 days before their estimated LMP, according to Ailes and colleagues.

The two discouraged drugs were among the most commonly prescribed antibiotics during the first trimester, with 34.7% of women filling prescriptions for nitrofurantoin and 7.6% filling prescriptions for trimethoprim-sulfamethoxazole, according to Ailes and colleagues.

“Given the recommendations to avoid these medications in early pregnancy if possible and the fact that nearly 50% of pregnancies in the United States are unintended, it is important that health care providers of various specialties be aware of these recommendations and that they might be ‘treating for two’ when prescribing antibiotic treatments for UTIs to pregnant women and women who might become pregnant in the near future,” they wrote. – Gerard Gallagher

References:

Ailes EC, et al. MMWR Morb Mortal Wkly Rep. 2018;doi:10.15585/mmwr.mm6701a4.

American College of Obstetricians and Gynecologists Committee on Obstetric Practice. Sulfonamides, nitrofurantoin, and the risk of birth defects. https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Sulfonamides-Nitrofurantoin-and-Risk-of-Birth-Defects. Accessed January 11, 2018.

Gupta K, et al. Clin Infect Dis. 2011;doi:10.1093/cid/ciq257.

Disclosures: The authors report no relevant financial disclosures.