Book contents
- Frontmatter
- Dedication
- Contents
- List of Contributors
- Preface
- Part I Clinical syndromes: general
- Part II Clinical syndromes: head and neck
- Part III Clinical syndromes: eye
- Part IV Clinical syndromes: skin and lymph nodes
- Part V Clinical syndromes: respiratory tract
- Part VI Clinical syndromes: heart and blood vessels
- Part VII Clinical syndromes: gastrointestinal tract, liver, and abdomen
- Part VIII Clinical syndromes: genitourinary tract
- Part IX Clinical syndromes: musculoskeletal system
- Part X Clinical syndromes: neurologic system
- Part XI The susceptible host
- 84 Evaluation of suspected immunodeficiency
- 85 Infections in the neutropenic patient
- 86 Infections in patients with neoplastic disease
- 87 Corticosteroids, cytotoxic agents, and infection
- 88 Biologics
- 89 Infections in transplant recipients
- 90 Diabetes and infection
- 91 Infectious complications in the injection and non-injection drug user
- 92 Infections in the alcoholic
- 93 Infections in the elderly
- 94 Neonatal infection
- 95 Pregnancy and the puerperium: infectious risks
- 96 Dialysis-related infection
- 97 Overwhelming postsplenectomy infection
- Part XII HIV
- Part XIII Nosocomial infection
- Part XIV Infections related to surgery and trauma
- Part XV Prevention of infection
- Part XVI Travel and recreation
- Part XVII Bioterrorism
- Part XVIII Specific organisms: bacteria
- Part XIX Specific organisms: spirochetes
- Part XX Specific organisms: Mycoplasma and Chlamydia
- Part XXI Specific organisms: Rickettsia, Ehrlichia, and Anaplasma
- Part XXII Specific organisms: fungi
- Part XXIII Specific organisms: viruses
- Part XXIV Specific organisms: parasites
- Part XXV Antimicrobial therapy: general considerations
- Index
- References
95 - Pregnancy and the puerperium: infectious risks
from Part XI - The susceptible host
Published online by Cambridge University Press: 05 April 2015
- Frontmatter
- Dedication
- Contents
- List of Contributors
- Preface
- Part I Clinical syndromes: general
- Part II Clinical syndromes: head and neck
- Part III Clinical syndromes: eye
- Part IV Clinical syndromes: skin and lymph nodes
- Part V Clinical syndromes: respiratory tract
- Part VI Clinical syndromes: heart and blood vessels
- Part VII Clinical syndromes: gastrointestinal tract, liver, and abdomen
- Part VIII Clinical syndromes: genitourinary tract
- Part IX Clinical syndromes: musculoskeletal system
- Part X Clinical syndromes: neurologic system
- Part XI The susceptible host
- 84 Evaluation of suspected immunodeficiency
- 85 Infections in the neutropenic patient
- 86 Infections in patients with neoplastic disease
- 87 Corticosteroids, cytotoxic agents, and infection
- 88 Biologics
- 89 Infections in transplant recipients
- 90 Diabetes and infection
- 91 Infectious complications in the injection and non-injection drug user
- 92 Infections in the alcoholic
- 93 Infections in the elderly
- 94 Neonatal infection
- 95 Pregnancy and the puerperium: infectious risks
- 96 Dialysis-related infection
- 97 Overwhelming postsplenectomy infection
- Part XII HIV
- Part XIII Nosocomial infection
- Part XIV Infections related to surgery and trauma
- Part XV Prevention of infection
- Part XVI Travel and recreation
- Part XVII Bioterrorism
- Part XVIII Specific organisms: bacteria
- Part XIX Specific organisms: spirochetes
- Part XX Specific organisms: Mycoplasma and Chlamydia
- Part XXI Specific organisms: Rickettsia, Ehrlichia, and Anaplasma
- Part XXII Specific organisms: fungi
- Part XXIII Specific organisms: viruses
- Part XXIV Specific organisms: parasites
- Part XXV Antimicrobial therapy: general considerations
- Index
- References
Summary
Infectious diseases that occur during pregnancy and the puerperium pose special risks to the mother, fetus, and infant. Any intervention must be weighed against possible side effects.
Urinary tract infections
For pregnant women it is recommended to culture urine at the first prenatal visit. Treatment should be provided if the urine culture is positive.
Short courses (3 days) of antimicrobial therapy are usually effective in eradicating asymptomatic bacteriuria. Penicillins, cephalosporins, aztreonam, ertapenem, imipenem, and meropenem are considered safe. Sulfonamides, including TMP–SMX, are avoided in the first trimester and near term (because of kernicterus).
Recommended regimens include amoxicillin, 500 mg orally three times a day; amoxicillin–clavulanate, 875mg twice a day; nitrofurantoin, 100mg every 12 hours; sulfisoxazole, 500 mg three times a day; cephalosporins, such as cefuroximeaxetil, 250 to 500mg every 12 hours, or cefpodoxime, 100mg every 12 hours, can also be used. Fosfomycin, 3 g PO as a single dose, was shown to be effective when compared with other drugs administered for a longer time.
Urine culture should be performed 1 week after therapy and monthly until the end of pregnancy. Suppressive therapy until delivery is recommended for women who have persistent bacteriuria after two or more courses of therapy.
In acute cystitis, pyuria is found in most patients, and urine culture should be performed. Patients should be treated for 3 to 7 days if symptoms suggesting pyelonephritis are absent. The same antibiotic regimens suggested for asymptomatic bacteriuria can be utilized. Quinolones are contraindicated in pregnancy. Follow-up urine culture should be obtained 1 week after therapy. For recurrent infections, antimicrobial prophylaxis should be considered for the duration of pregnancy.
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- Clinical Infectious Disease , pp. 615 - 621Publisher: Cambridge University PressPrint publication year: 2015