Less common bacterial, fungal and viral infections: review of management in the pregnant patient

Drugs in Context

article

Milena Murray¹  Alyssa P Gould³  Hana R Winders⁴  Kayla R Stover⁶  P Brandon Bookstaver⁴  Brooke Griffin¹  Christopher M Bland⁷  Lea S Eiland⁸ 

[1] Midwestern University College of Pharmacy;Northwestern Memorial Hospital;Novant Health;University of South Carolina College of Pharmacy;Prisma Health Midlands;University of Mississippi School of Pharmacy;University of Georgia College of Pharmacy;Auburn University Harrison School of Pharmacy

关键词: antibiotics;    antifungals;    antivirals;    bacterial infection;    fungal infection;    pregnancy;    teratogenicity;    viral infection;   

DOI  :  10.7573/dic.2021-4-3

学科分类：社会科学、人文和艺术（综合）

来源: C S F Medical Communications Ltd.

【 摘 要 】

This review is a comprehensive summary of treatment options for pregnant patients with less common bacterial, fungal, and viral infections. It offers guidance to clinicians based on the most recently published evidence-based research and expert recommendations. A search of MEDLINE (inception to March 2021) and the CDC website was performed. Liposomal amphotericin B is the preferred therapy for cryptococcosis, histoplasmosis, oesophageal candidiasis, and coccidioidomycosis, especially during the first trimester due to teratogenic concerns with azole antifungals. For oral candidiasis, clotrimazole troches or miconazole mucoadhesive buccal tablets are recommended. A β-lactam antimicrobial is preferred over doxycycline for various manifestations of Lyme disease and the drug of choice for Pneumocystis pneumonia is trimethoprim/sulfamethoxazole. Acyclovir is the preferred antiviral for varicella zoster virus. Fluoroquinolones, macrolides, and aminoglycosides should be avoided if possible and there are alternate agents available for an effective treatment regimen. There is a scarcity of clinical data in pregnant patients with less common bacterial, fungal and viral infections. This population lacks definitive recommendations in many clinical practice guidelines. The key to optimizing therapy is a comprehensive review of the available evidence and a careful balance of risks and benefits before final treatment decisions.

【 授权许可】

CC BY-NC-ND