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Harbison AF, Polly DM, Musselman ME. Antiinfective therapy for pregnant or lactating patients in the emergency department. Am J Health Syst Pharm 2015; 72:189-97. [PMID: 25596601 DOI: 10.2146/ajhp130797] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Special considerations in pharmacotherapy for infectious diseases in pregnant and lactating women in the emergency department (ED) setting are reviewed. SUMMARY With many women turning to the ED as a source of primary care, it is essential for pharmacists involved in providing ED services to guide the selection of appropriate antiinfective agents during pregnancy and lactation; this area of practice is complicated by the very limited body of published data on the safety and efficacy of maternal antimicrobial use and potential fetal or neonatal adverse effects. Infectious diseases commonly encountered in the ED include sexually transmitted diseases, bacterial vaginosis and other vaginal infections, respiratory and urinary tract infections, and pneumonia. Recommended first-line therapies for pregnant or lactating women may differ from those recommended for other patient populations. Although some widely used antiinfective classes and agents are generally considered safe for use in pregnant women, others (e.g., clarithromycin, fluoroquinolones) have been linked to birth defects and neonatal adverse effects. In addition to guiding ED practitioners in the appropriate use of antiinfective agents in pregnant women and nursing mothers, pharmacists can reinforce the importance of appropriate follow-up care (including specialist referral or culture testing in some cases) and ongoing preventive health measures such as vaccine administration. CONCLUSION The use of antiinfective agents in pregnant or lactating women requires consideration not only of the drugs' effectiveness but also their possible effects on the fetus or newborn and the nature of follow-up care. References are available to help clinicians make treatment decisions.
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Affiliation(s)
- Ashley F Harbison
- Ashley F. Harbison, Pharm.D., BCPS, is Clinical Pharmacist, The University of Kansas Hospital, Kansas City. Derek M. Polly, Pharm.D., is Clinical Pharmacy Specialist, Pulmonary/Critical Care Medicine, Emory University Hospital-Midtown, Atlanta, GA. Megan E. Musselman, Pharm.D., M.S., BCPS, is Clinical Pharmacy Specialist, Emergency Medicine/Critical Care, North Kansas City Hospital, Kansas City, MO
| | - Derek M Polly
- Ashley F. Harbison, Pharm.D., BCPS, is Clinical Pharmacist, The University of Kansas Hospital, Kansas City. Derek M. Polly, Pharm.D., is Clinical Pharmacy Specialist, Pulmonary/Critical Care Medicine, Emory University Hospital-Midtown, Atlanta, GA. Megan E. Musselman, Pharm.D., M.S., BCPS, is Clinical Pharmacy Specialist, Emergency Medicine/Critical Care, North Kansas City Hospital, Kansas City, MO
| | - Megan E Musselman
- Ashley F. Harbison, Pharm.D., BCPS, is Clinical Pharmacist, The University of Kansas Hospital, Kansas City. Derek M. Polly, Pharm.D., is Clinical Pharmacy Specialist, Pulmonary/Critical Care Medicine, Emory University Hospital-Midtown, Atlanta, GA. Megan E. Musselman, Pharm.D., M.S., BCPS, is Clinical Pharmacy Specialist, Emergency Medicine/Critical Care, North Kansas City Hospital, Kansas City, MO.
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Abstract
The epidemiology of tuberculosis has changed dramatically over the past 5 years with significant shifts in at-risk populations, resulting in increased disease among young adults and children, especially among those from developing countries. Congenital tuberculosis is rare, and the clinical presentation of tuberculosis during pregnancy and infancy is often non-specific, making recognition difficult. Advances have been made with diagnostic tools, in public health practices, and with treatment recommendations. Controversy and debate continue regarding the safety and use of isoniazid for latent tuberculosis infection during pregnancy. New vaccine development may be promising for the future, but much work is needed to understand the complicated immune response to tuberculosis.
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MESH Headings
- BCG Vaccine/immunology
- Female
- Humans
- Infant, Newborn
- Infant, Newborn, Diseases/diagnosis
- Infant, Newborn, Diseases/drug therapy
- Infant, Newborn, Diseases/epidemiology
- Infant, Newborn, Diseases/prevention & control
- Isoniazid/therapeutic use
- Pregnancy
- Pregnancy Complications, Infectious/diagnosis
- Pregnancy Complications, Infectious/drug therapy
- Pregnancy Complications, Infectious/epidemiology
- Pregnancy Complications, Infectious/prevention & control
- Tuberculosis/congenital
- Tuberculosis/diagnosis
- Tuberculosis/drug therapy
- Tuberculosis/epidemiology
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Affiliation(s)
- Kim Connelly Smith
- The University of Texas-Houston Medical School, Houston, Texas 77030, USA.
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