Use of antibiotics in pregnancy
A Canadian case-control study has found new evidence of increased risk of spontaneous abortion associated with use of antibiotics in pregnancy (Flory TM et al. Use of antibiotics during pregnancy and risk of spontaneous abortion. CMAJ. 2017; 1(189):625-33: http://www.cmaj.ca/content/189/17/E625).
Public Health England (PHE) now states:
in pregnancy, take specimens to inform treatment, use this guidance or seek specialist advice. Penicillins, cephalosporins and erythromycin are not associated with increased risks. If possible, avoid tetracyclines, quinolones, aminoglycosides, azithromycin, clarithromycin and high dose metronidazole 2g stat unless the benefit outweighs the risk. 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.
Further analysis from this Canadian study suggests increased risk of major congenital malformations associated with certain antibiotics. The antibiotics in this study which increased the risk included erythromycin, doxycycline, phenoxymethylpenicillin, ofloxacin, clindamycin, moxifloxacin. The authors highlight that the results should be interpreted with caution as only a small number of cases were exposed to antibiotics. The absolute increased risk remains small, but the authors suggest clinicians use other antibiotics for pregnant women.
Leaflets and forms
One can be used during consultations with women who are experiencing non-complicated urinary tract infections, when the clinician feels that the patient does not require an antibiotic prescription:
The leaflet is available in different languages from the TARGET website.
FOR CARE HOME STAFF: Form to complete and fax to GP if an older resident has a suspected urinary tract infection:
Primary Care Antimicrobial Guidelines
Public Health England (PHE) has updated sections of the PHE management of infection for primary care guidance, which is for consultation and local adaptation. This is currently being used to update our local guidelines (the summary diagram and full guideline will be put back on the website once these changes have been made).
Diagnosis of UTI – Quick Reference Guide for Primary Care
In the process of being reviewed:
These guidelines should be used in conjunction with professional judgement and involving patients in management decisions.
For hospital patients and visitors
Public Health England has produced a patient information leaflet about an uncommon fungus called Candida auris.
CCGs are continuing to work with healthcare professionals, patients and the public to reduce inappropriate prescribing of antibiotics. In addition, from 1 April 2017 we will be working to reduce gram negative blood stream infections (BSI) across the whole health economy and reduce inappropriate antibiotic prescribing for urinary tract infections (UTI) in primary care.
Hospitals are working on reducing the impact of serious infections. This includes timely identification and treatment of sepsis and a reduction of clinically inappropriate antibiotic prescription and consumption. Further details are here.