Trimethoprim can be used in women if she has no folate deficiency
or if she is not using folate antagonists. Trimethoprim can be given with folic
acid to avoid neural tube defects in fetus during the first trimester of
pregnancy. Trimethoprim cannot be used repeatedly (within three months) due to
recurrent infections resistant to this drug.
Co-amoxiclav which is a combination of amoxicillin and
clavulanic acid can be tolerated well in pregnancy. Nitrofurantoin can be used
in women if she is not glucose 6 phosphate dehydrogenase deficient, if G6PD
deficient then infant has chance of hemolysis if used near term, so it is not
recommended to use during third trimester of pregnancy. The tablet formulation
of nitrofurantoin can be better tolerated. Other formulation that is
microcrystalline powder filled capsules as twice daily modified release can be
used as an alternative if there is nausea.
Second generation cephalosporins are not well absorbed orally
and are more expensive than first generation cephalosporins and have more
gastrointestinal side effects, so are used only when specifically indicated.
Third generation cephalosporins are only used parenterally and
are reserved for use in hospital settings.
Pivmecillinam is not known to be teratogenic but is not
recommended to be used in pregnancy because of insufficient safety data
available.
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