medications

  • Sulfamethoxazole-Trimethoprim – Some avoid in first trimester (see TMP) and at term (kernicterus)
  • Trimethoprim – Folate inhibition may be associated with teratogenicity in first trimester
  • Nitrofurantoin – safe according to most studies
  • Fosfomycin – considered safe
  • Quinolones – no human teratogenic influence shown, but animal studies suggest possibility
  • β-lactams – considered safe

Duration

  • Single dose (cystitis)
    • Only fosfomycin (lasts ≈ 3 days)
  • 3 days (cystitis)
    • TMP-SMX, TMP, quinolones, ? some β-lactams
  • 5 – 7 days
    • Nitrofurantoin, β-lactams, quinolones
  • 10 – 14 days (pyelonephritis)
    • TMP-SMX, TMP, β-lactams, quinolones

Nitrofurantoin ADE

  • GI – usually mild but may be adherence limiting
  • Hepatotoxicity
  • Neurologic, especially with Ccr < 30-60 ml/min
  • Two types of pulmonary ADRs
  • Can present like pneumonia and/or heart failure, especially in elderly, institutionalized patients…..
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