Since 2011, a committee opinion from the American College of Obstetricians and Gynecologists (ACOG) has recommended against use of sulfonamides and nitrofurantoin for urinary tract infections (UTI) during the first trimester of pregnancy, unless all other antibiotics are clinically inappropriate.
The CDC conducted a database analysis of 483,000 pregnancies (2013-2015) to assess compliance with the ACOG recommendation. UTIs occurred in 3% of pregnancies during the first trimester; 69% resulted in antibiotic treatment. Nitrofurantoin or sulfonamides were prescribed in 61% of cases; preferred antibiotics (eg, cephalosporins, fluoroquinolones) were prescribed in only 33% of cases.
Nearly half of US pregnancies are unintended; therefore, antibiotic exposure may occur before a woman knows she is pregnant. Assuming no compelling reason (allergy, allergy, culture & sensitivity results) to avoid cephalosporins or fluroquinolones, they should be considered first when treating a UTI in a woman of child bearing age.
• Ailes EC, et al. MMWR 2018;67:18-22.