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Orwa SA, Gudnadottir U, Boven A, Pauwels I, Versporten A, Vlieghe E, Brusselaers N. Global prevalence of antibiotic consumption during pregnancy: A systematic review and meta-analysis. J Infect 2024; 89:106189. [PMID: 38844084 DOI: 10.1016/j.jinf.2024.106189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 05/22/2024] [Accepted: 05/27/2024] [Indexed: 06/14/2024]
Abstract
BACKGROUND Antibiotic use during pregnancy is widespread with notable variations across regions. METHODS This systematic review and meta-analysis (Prospero protocol CRD42023418979) examines the prevalence and variability of antibiotic use in pregnancy globally and regionally, considering different methodologies and maternal characteristics. We searched Embase, PubMed, and Web of Science for observational studies published in English from the year 2000 and onwards. Random-effect meta-analyses were used to pool the prevalence of antibiotic consumption during pregnancy, presented as percentages with 95% confidence intervals (CI). Joanna Briggs Institute Critical appraisal checklist for prevalence studies was used for bias assessment. FINDINGS Overall, 116 studies (14 from Africa, 24 from the Americas, six from Eastern Mediterranean, 57 from Europe, four from South-East Asia and 11 from Western Pacific) were included (33,821,194 pregnancies). The majority of studies (84.5%) were appraised with a low risk of bias. The prevalence of antibiotic consumption during pregnancy ranged between 0.04 to 90%, with a pooled estimate of 23.6% (95% CI: 20.1-27.5, I2 =100%). Low-income countries had the highest pooled prevalence (45.3%, 95% CI: 15.4-79.1, I2 =99.6%). Regionally, the Western Pacific had the highest pooled prevalence (34.4%, 95% CI: 13.4-64.1, I2 =100%). The prevalence of antibiotic consumption during pregnancy increased over time in the Americas and Western Pacific. The studies exhibited considerable heterogeneity (I2 >95%), and the trim-and-fill method estimated a potential 10% underestimation of the overall pooled prevalence, suggesting publication bias. INTERPRETATION This meta-analysis suggests that about 1/4 of women worldwide use antibiotics during pregnancy. This study suggests a high prevalence of antibiotic consumption during pregnancy with disparities according to region and level of country income, ethnicity and whether antibiotics were prescribed or self-medicated. There was a variability in reported findings across age categories, potential bias from small sample sizes, and language bias from including only studies published in English.
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Affiliation(s)
- Sheila A Orwa
- Global Health Institute, Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium
| | - Unnur Gudnadottir
- Centre for Translational Microbiome Research, Department of Microbiology, Tumour and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - Annelies Boven
- Global Health Institute, Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium; Centre for Translational Microbiome Research, Department of Microbiology, Tumour and Cell Biology, Karolinska Institutet, Stockholm, Sweden; Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Ines Pauwels
- Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Ann Versporten
- Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Erika Vlieghe
- Global Health Institute, Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium; Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium; General Internal Medicine, Infectious Diseases and Tropical Medicine, Antwerp University Hospital, Antwerp, Belgium
| | - Nele Brusselaers
- Global Health Institute, Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium; Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.
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Goto M, Anzai T, Yamane R, Yakuwa N, Takahashi K, Murashima A. Pregnancy outcomes after first-trimester exposure to fluoroquinolones: Findings based on an integrated database from two Japanese institutions. Congenit Anom (Kyoto) 2024. [PMID: 38936845 DOI: 10.1111/cga.12577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 05/02/2024] [Accepted: 06/10/2024] [Indexed: 06/29/2024]
Abstract
Given the paucity of safety data on fluoroquinolone antibiotics in pregnancy, a prospective observational cohort study was conducted in pregnant women who sought help and advice on drug use at two teratology information institutes in Japan. The primary endpoint of the study was the incidence of major congenital anomalies. The study population included pregnant women exposed to (i) fluoroquinolones (fluoroquinolone group), (ii) β-lactams (infectious control group), or (iii) other agents considered to be nonteratogenic in humans (nonteratogenic control group) during the first trimester. The frequency of major congenital anomalies was compared across groups using a logistic regression model that adjusted for maternal age, smoking status, drinking status, facility consulted, and time of consultation. The fluoroquinolone group consisted of 411 women who had 383 children born alive. The infectious control and nonteratogenic control groups consisted of 1416 and 1482 women who had 1322 and 1401 children born alive, respectively. The incidence of major congenital anomalies was 1.5%, 2.0%, and 1.6% in the fluoroquinolone group, infectious control, and nonteratogenic control groups, respectively. Logistic regression showed that fluoroquinolone exposure is not a significant risk factor for major congenital anomalies. In conclusion, first-trimester exposure to fluoroquinolone antibiotics was not associated with increased maternal or fetal risks.
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Affiliation(s)
- Mikako Goto
- Pregnancy and Drug Information Center, The Japan Drug Information Institute in Pregnancy, National Center for Child Health and Development, Tokyo, Japan
| | - Tatsuhiko Anzai
- Department of Biostatistics, M&D Data Science Center, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ritsuko Yamane
- Department of Pharmacy, Toranomon Hospital, Minato-ku, Japan
| | - Naho Yakuwa
- Pregnancy and Drug Information Center, The Japan Drug Information Institute in Pregnancy, National Center for Child Health and Development, Tokyo, Japan
| | - Kunihiko Takahashi
- Department of Biostatistics, M&D Data Science Center, Tokyo Medical and Dental University, Tokyo, Japan
| | - Atsuko Murashima
- Pregnancy and Drug Information Center, The Japan Drug Information Institute in Pregnancy, National Center for Child Health and Development, Tokyo, Japan
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Laube R, Selinger CP, Seow CH, Christensen B, Flanagan E, Kennedy D, Mountifield R, Seeho S, Shand A, Williams AJ, Leong RW. Australian inflammatory bowel disease consensus statements for preconception, pregnancy and breast feeding. Gut 2023; 72:1040-1053. [PMID: 36944479 DOI: 10.1136/gutjnl-2022-329304] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 02/21/2023] [Indexed: 03/23/2023]
Abstract
OBJECTIVE Because pregnancy outcomes tend to be worse in women with inflammatory bowel disease (IBD) than in those without, we aimed to update consensus statements that guide the clinical management of pregnancy in patients with IBD. DESIGN A multidisciplinary working group was established to formulate these consensus statements. A modified RAND/UCLA appropriateness method was used, consisting of a literature review, online voting, discussion meeting and a second round of voting. The overall agreement among the delegates and appropriateness of the statement are reported. RESULTS Agreement was reached for 38/39 statements which provide guidance on management of pregnancy in patients with IBD. Most medications can and should be continued throughout pregnancy, except for methotrexate, allopurinol and new small molecules, such as tofacitinib. Due to limited data, no conclusion was reached on the use of tioguanine during pregnancy. Achieving and maintaining IBD remission before conception and throughout pregnancy is crucial to optimise maternofetal outcomes. This requires a multidisciplinary approach to engage patients, allay anxieties and maximise adherence tomedication. Intestinal ultrasound can be used for disease monitoring during pregnancy, and flexible sigmoidoscopy or MRI where clinically necessary. CONCLUSION These consensus statements provide up-to-date, comprehensive recommendations for the management of pregnancy in patients with IBD. This will enable a high standard of care for patients with IBD across all clinical settings.
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Affiliation(s)
- Robyn Laube
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
- Department of Gastroenterology, Macquarie University Hospital, Sydney, New South Wales, Australia
| | | | - Cynthia H Seow
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Britt Christensen
- Gastroenterology Department, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Emma Flanagan
- Department of Gastroenterology, University of Melbourne, Melbourne, Victoria, Australia
| | - Debra Kennedy
- MotherSafe, Royal Hospital for Women, Sydney, New South Wales, Australia
| | - Reme Mountifield
- Department of Gastroenterology, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Sean Seeho
- Department of Obstetrics and Gynaecology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Antonia Shand
- Department of Maternal Foetal Medicine, Royal Hospital for Women, Sydney, New South Wales, Australia
| | - Astrid-Jane Williams
- Department of Gastroenterology, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Rupert W Leong
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
- Department of Gastroenterology, Macquarie University Hospital, Sydney, New South Wales, Australia
- Gastroenterology and Liver Services, Concord Repatriation General Hospital, Concord, New South Wales, Australia
- The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
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4
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Ukah UV, Aibibula W, Platt RW, Dayan N, Reynier P, Filion KB. Time-related biases in perinatal pharmacoepidemiology: A systematic review of observational studies. Pharmacoepidemiol Drug Saf 2022; 31:1228-1241. [PMID: 35753061 DOI: 10.1002/pds.5504] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 06/14/2022] [Accepted: 06/23/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Time-related biases, such as immortal time and time-window bias, frequently occur in pharmacoepidemiologic research. However, the prevalence of these biases in perinatal pharmacoepidemiology is not well understood. OBJECTIVE To describe the frequency of time-related biases in observational studies of medications commonly used during pregnancy (antibiotic, antifungal, and antiemetic drugs) via systematic review. METHOD We searched Medline and EMBASE for observational studies published between January 2013 and September 2020 and examining the association between antibiotic, antifungal, or antiemetic drugs and adverse pregnancy outcomes, including spontaneous abortion, stillbirth, preterm delivery, small-for-gestational age, pre-eclampsia, and gestational diabetes. The proportion of studies with time-related biases was estimated overall and by type (immortal time bias, time-window bias). RESULTS Our systematic review included 20 studies (16 cohort studies, 3 nested case-control studies, and 1 case-control study), of which 12 examined antibiotic, 6 antiemetic, and 2 anti-fungal drugs. Eleven studies (55%) had immortal time bias due to the misclassification of unexposed, event-free person-time between cohort entry and exposure initiation as exposed. No included study had time-window bias. The direction of effect varied for both studies with and without time-related bias, with many studies reporting very wide confidence intervals around the effect estimates, thus making the direction of effect less interpretable. However, studies with time-related bias were more likely to show protective or null associations compared with studies without time-related bias. CONCLUSION Time-related biases occur frequently in observational studies of drug effects during pregnancy. The use of appropriate study design and analytical approaches is needed to prevent time-related biases and ensure study validity.
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Affiliation(s)
- Ugochinyere Vivian Ukah
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada
| | - Wusiman Aibibula
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Canada
| | - Robert W Platt
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada.,Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Canada.,Department of Pediatrics, McGill University, Montreal, Canada.,Research Institute - McGill University Health Centre, Montreal, Canada
| | - Natalie Dayan
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada.,Research Institute - McGill University Health Centre, Montreal, Canada
| | - Pauline Reynier
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Canada
| | - Kristian B Filion
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada.,Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Canada.,Department of Medicine, McGill University, Montreal, Canada
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5
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Geng Y, Zhang T, Alonzo IG, Godar SC, Yates C, Pluimer BR, Harrison DL, Nath AK, Yeh JRJ, Drummond IA, Bortolato M, Peterson RT. Top2a promotes the development of social behavior via PRC2 and H3K27me3. SCIENCE ADVANCES 2022; 8:eabm7069. [PMID: 36417527 PMCID: PMC9683714 DOI: 10.1126/sciadv.abm7069] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 10/25/2022] [Indexed: 06/16/2023]
Abstract
Little is understood about the embryonic development of sociality. We screened 1120 known drugs and found that embryonic inhibition of topoisomerase IIα (Top2a) resulted in lasting social deficits in zebrafish. In mice, prenatal Top2 inhibition caused defects in social interaction and communication, which are behaviors that relate to core symptoms of autism. Mutation of Top2a in zebrafish caused down-regulation of a set of genes highly enriched for genes associated with autism in humans. Both the Top2a-regulated and autism-associated gene sets have binding sites for polycomb repressive complex 2 (PRC2), a regulatory complex responsible for H3K27 trimethylation (H3K27me3). Moreover, both gene sets are highly enriched for H3K27me3. Inhibition of the PRC2 component Ezh2 rescued social deficits caused by Top2 inhibition. Therefore, Top2a is a key component of an evolutionarily conserved pathway that promotes the development of social behavior through PRC2 and H3K27me3.
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Affiliation(s)
- Yijie Geng
- Department of Pharmacology and Toxicology, College of Pharmacy, University of Utah, Salt Lake City, UT 84112, USA
| | - Tejia Zhang
- Department of Pharmacology and Toxicology, College of Pharmacy, University of Utah, Salt Lake City, UT 84112, USA
| | - Ivy G. Alonzo
- Department of Pharmacology and Toxicology, College of Pharmacy, University of Utah, Salt Lake City, UT 84112, USA
| | - Sean C. Godar
- Department of Pharmacology and Toxicology, College of Pharmacy, University of Utah, Salt Lake City, UT 84112, USA
| | - Christopher Yates
- Department of Pharmacology and Toxicology, College of Pharmacy, University of Utah, Salt Lake City, UT 84112, USA
| | - Brock R. Pluimer
- Department of Pharmacology and Toxicology, College of Pharmacy, University of Utah, Salt Lake City, UT 84112, USA
| | - Devin L. Harrison
- The Graduate Program in Biophysical Sciences, The University of Chicago, Chicago, IL 60637, USA
| | - Anjali K. Nath
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02115, USA
- Cardiovascular Research Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA
- Metabolism Program, Broad Institute, Cambridge, MA 02142, USA
| | - Jing-Ruey Joanna Yeh
- Cardiovascular Research Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA
| | - Iain A. Drummond
- Davis Center for Aging and Regeneration, MDI Biological Laboratory, Bar Harbor, ME 04609, USA
| | - Marco Bortolato
- Department of Pharmacology and Toxicology, College of Pharmacy, University of Utah, Salt Lake City, UT 84112, USA
| | - Randall T. Peterson
- Department of Pharmacology and Toxicology, College of Pharmacy, University of Utah, Salt Lake City, UT 84112, USA
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Noergaard M, Gotfredsen DR, Sørensen AMS, Andersen JT. Ciprofloxacin exposure and adverse pregnancy outcomes: a Danish nationwide cohort study. BJOG 2021; 129:1503-1511. [PMID: 34954900 PMCID: PMC9544954 DOI: 10.1111/1471-0528.17083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 11/26/2021] [Accepted: 12/06/2021] [Indexed: 11/29/2022]
Abstract
Objective To examine the association between maternal exposure to ciprofloxacin and the risk of miscarriage and major malformations. Design A nationwide register‐based cohort study. Setting Data were obtained from the Medical Birth Registry, the National Hospital Registry, the Danish National Prescription Registry and Statistics Denmark. Population Data were collected in the period between 1997 and 2016 and included all registered pregnancies that ended in an elective termination, miscarriage, stillbirth or a live birth. Exposure was defined as redeeming one or more prescriptions of ciprofloxacin. Methods Miscarriage was defined as a diagnosis given before 22 weeks without any medical intervention. Major malformations were classified according to EUROCAT 1.4. We matched ciprofloxacin‐exposed pregnancies to unexposed pregnancies on the propensity score in a ratio 1:4. To estimate the hazard ratio (HR) of miscarriage a Cox proportional hazard regression model was used. A log binomial model was used to estimate the relative risk ratio (RR) of major malformations. Main outcome measures HR of miscarriage and the RR of major malformations. Results A total of 1 650 649 pregnancies were identified. Of these, 10 250 (2050 ciprofloxacin‐exposed) and 6100 (1220 ciprofloxacin‐exposed) were included in the miscarriage and major malformation analysis, respectively. The HR of miscarriage was 0.99 (95% confidence interval [CI] 0.84–1.17). For major malformation, the RR was 1.01 (95% CI 0.72–1.40). For the organ‐specific major malformations and the sensitivity analyses, no significant increased risks were identified. Conclusion We demonstrated no association between miscarriage and maternal ciprofloxacin exposure within the first 22 weeks of pregnancy, or between major malformations and maternal exposure during the first trimester. Tweetable abstract No association between maternal ciprofloxacin exposure and adverse pregnancy outcomes. No association between maternal ciprofloxacin exposure and adverse pregnancy outcomes.
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Affiliation(s)
- Mia Noergaard
- Department of Clinical Pharmacology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Ditte Resendal Gotfredsen
- Department of Clinical Pharmacology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Anne Mette Skov Sørensen
- Department of Clinical Pharmacology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Jon Traerup Andersen
- Department of Clinical Pharmacology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark.,University of Copenhagen, Faculty of Health and Medical Sciences, Copenhagen, Denmark
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Perin J, Coleman JS, Ronda J, Neibaur E, Gaydos CA, Trent M. Maternal and Fetal Outcomes in an Observational Cohort of Women With Mycoplasma genitalium Infections. Sex Transm Dis 2021; 48:991-996. [PMID: 34654767 PMCID: PMC8595487 DOI: 10.1097/olq.0000000000001569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Despite evidence that Mycoplasma genitalium (MG) is a risk factor for adverse outcomes in pregnancy, screening in pregnant women is not currently recommended. METHODS Pregnant women between the ages of 13 and 29 years were recruited during their routine prenatal visits, screened for sexually transmitted infections (STIs) and followed for 1 year. We compared women with MG to those with no STIs, excluding women with STIs other than MG (Chlamydia trachomatis [CT], Neisseria gonorrhoeae [NG], or Trichomonas vaginalis [TV]) unless they were also codiagnosed with MG. Adverse outcomes were extracted from participants' medical records and compared between women with MG and those without STIs using exact or nonparametric approaches. Estimated differences were also adjusted for demographics using propensity scores with linear and logistic regression, where appropriate. We exclude women with MG and CT, NG, or TV diagnosis for primary analysis. RESULTS Of 281 participants enrolled from September 2015 until July 2019, 51 (18.1%) were diagnosed with MG. Of 51 women with MG, 12 (24%) were also diagnosed with CT, NG, or TV. All women with MG were offered treatment with azithromycin; however, only 28 (55%) were documented to receive treatment. Women with MG had similar outcomes to those with no STIs with a few exceptions. Average birth weight was lower among women with MG alone compared with women with no STIs when excluding coinfections (169-g difference, 15-323). CONCLUSIONS Our results indicate that MG is common in pregnant women and often presents as a coinfection. More research using population-based designs is needed to determine whether screening or treatment for women at risk for low birth weight or coinfections is warranted.
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Affiliation(s)
| | - Jenell S Coleman
- Department of Obstetrics and Gynecology, Johns Hopkins School of Medicine, Baltimore, MD
| | | | - Erica Neibaur
- From the Department of Pediatrics, Johns Hopkins School of Medicine
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8
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Noergaard M, Jensen PB, Resendal Gotfredsen D, Bergholt T, Trærup Andersen J, Mathiesen L. Therapeutic concentration of ciprofloxacin and transfer across the human term placenta. Am J Obstet Gynecol 2021; 225:670.e1-670.e9. [PMID: 34058171 DOI: 10.1016/j.ajog.2021.05.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 05/07/2021] [Accepted: 05/15/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Pregnant women have an increased risk of infections, and early and decisive treatment is preferred to prevent complications. Although ciprofloxacin is very commonly used, safety aspects of maternal treatment during pregnancy are limited, and avoidance of its use during late pregnancy is recommended. OBJECTIVE The aim is to estimate maternal-to-fetal transfer clearance of ciprofloxacin at a therapeutic concentration and to determine fetal exposure to maternally administered ciprofloxacin. STUDY DESIGN Transplacental pharmacokinetics were determined with an ex vivo placental model, which is a reliable experimental model for estimating fetal drug exposure. Human placentas from uncomplicated term pregnancies were collected after delivery and a suitable cotyledon was cannulated. Ciprofloxacin was added at a therapeutic concentration (1.6 μg/mL) to the maternal compartment, and antipyrine was included as a reference drug (10.0 μg/mL). Samples were collected from the maternal and fetal compartment at 12 time points (-2 to 180 minutes), and the integrity and metabolic parameters were measured consecutively. Drug concentrations were determined using ultra-performance liquid chromatography-tandem mass spectrometry. RESULTS A total of 5 human placentas from healthy term pregnancies were collected after delivery and cannulated with success. Ciprofloxacin crossed the placenta; its mean concentration in the fetal compartment was 0.3 μg/mL, accounting for 22% (0.29/1.30; range, 15%-31%) of the maternal concentration after 3 hours. The fetal/maternal ciprofloxacin concentration ratio increased gradually over time and reached 0.53. The transfer clearance for ciprofloxacin was 0.28 mL/min (range, 0.21-0.41 mL/min) during the first hour and 0.21 mL/min (range, 0.14-0.26 mL/min) during the following 2 hours. After end perfusion, the mean tissue concentration and proportion of ciprofloxacin were 0.7 μg/g and 11% (14/130; range, 7%-14%), respectively. CONCLUSION Ciprofloxacin crossed the placenta at a slow, constant rate, indicating moderate fetal exposure. This study verifies an accumulation of ciprofloxacin in the placenta that may lengthen the duration of fetal exposure. These results are an essential element of fetal risk assessment, but further studies are needed to estimate fetal safety.
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Collier EK, Seivright JR, Shi VY, Hsiao JL. Pregnancy and breastfeeding in hidradenitis suppurativa: A review of medication safety. Dermatol Ther 2020; 34:e14674. [PMID: 33320387 DOI: 10.1111/dth.14674] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 11/30/2020] [Accepted: 12/11/2020] [Indexed: 12/22/2022]
Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory disease that disproportionately affects women of childbearing age. Pregnancy influences HS severity for many women, thus diligent continued management throughout pregnancy and postpartum may be required. Herein, we provide an updated review of pregnancy and lactation safety data for HS medications, including topical antiseptic washes, topical and systemic antibiotics, biologic and nonbiologic immunomodulators, immunosuppressants, adjunct medical therapies, and pain medications, to help guide risk-benefit discussions between providers and HS patients.
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Affiliation(s)
- Erin K Collier
- David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Justine R Seivright
- David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Vivian Y Shi
- Department of Dermatology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Jennifer L Hsiao
- Division of Dermatology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California, USA
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10
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Gandhi AR, Rao SR, Chen LH, Nelson MD, Ryan ET, LaRocque RC, Hyle EP. Prescribing Patterns of Antibiotics for the Self-Treatment of Travelers' Diarrhea in Global TravEpiNet, 2009-2018. Open Forum Infect Dis 2020; 7:ofaa376. [PMID: 33072808 PMCID: PMC7545114 DOI: 10.1093/ofid/ofaa376] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 08/25/2020] [Indexed: 12/26/2022] Open
Abstract
Background International travelers are often prescribed antibiotics for self-treatment of travelers' diarrhea (TD), but the benefits and risks of antibiotics are debated. We assessed the prescribing patterns of empiric antibiotics for TD in international travelers evaluated at Global TravEpiNet (GTEN) sites (2009-2018). Methods We performed a prospective, multisite cross-sectional study regarding antibiotic prescriptions for the self-treatment of TD at 31 GTEN sites providing pretravel consultations to adult international travelers. We described traveler demographics, itineraries, and antibiotic(s) prescribed. We used multivariable logistic regressions to assess the association of year of consultation with antibiotic prescribing (yes/no) and class (fluoroquinolones vs azithromycin). We performed interrupted time-series analyses to examine differences in prescribing before and after the Food and Drug Administration (FDA) warning on fluoroquinolones (July 2016). Results Antibiotics were not prescribed in 23 096 (22.2%) of 103 843 eligible pretravel GTEN consultations; azithromycin and fluoroquinolones were most frequently prescribed. Antibiotic prescribing declined significantly each year between 2009 and 2018 (odds ratio [OR], 0.84; 95% CI, 0.79-0.89), as did fluoroquinolone prescribing, relative to azithromycin (OR, 0.77; 95% CI, 0.73-0.82). The rate of decline in fluoroquinolone prescribing was significantly greater after the FDA fluoroquinolone warning (15.3%/year) than before (1.1%/year; P < .001). Conclusions Empiric antibiotics for TD were prescribed in >75% of pretravel GTEN consultations, but antibiotic prescribing declined steadily between 2009 and 2018. Fluoroquinolones were less frequently prescribed than azithromycin, especially after the 2016 FDA fluoroquinolone warning. Emphasis on the risks of antibiotics may influence antibiotic prescribing by providers for empiric treatment of TD.
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Affiliation(s)
- Aditya R Gandhi
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sowmya R Rao
- Biostatistics Center, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Lin H Chen
- Travel Medicine Center, Mount Auburn Hospital, Cambridge, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Michael D Nelson
- Travel Medicine Center, Mount Auburn Hospital, Cambridge, Massachusetts, USA
| | - Edward T Ryan
- Harvard Medical School, Boston, Massachusetts, USA.,Travelers' Advice and Immunization Center, Massachusetts General Hospital, Boston, Massachusetts, USA.,Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Regina C LaRocque
- Harvard Medical School, Boston, Massachusetts, USA.,Travelers' Advice and Immunization Center, Massachusetts General Hospital, Boston, Massachusetts, USA.,Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Emily P Hyle
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Travelers' Advice and Immunization Center, Massachusetts General Hospital, Boston, Massachusetts, USA.,Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
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Association of antibiotics therapy during pregnancy with spontaneous miscarriage: a systematic review and meta-analysis. Arch Gynecol Obstet 2020; 302:5-22. [PMID: 32409925 DOI: 10.1007/s00404-020-05569-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 04/25/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE This systematic review and meta-analysis of observational studies were conducted to assess the association between antibiotics use during pregnancy and spontaneous miscarriage. METHODS A systematic search of online databases as well as reference lists of retrieved studies were performed up to September 2018 to identify observational studies that investigated the association between antibiotics use and spontaneous miscarriage. The retrieved studies were assessed for methodological quality. Pooled relative risk (RR) and 95% confidence intervals were calculated using DerSimonian and Laird method. Random-effects meta-analysis was used to account for conceptual heterogeneity. Sensitivity analysis was performed to assess the robustness of pooled estimates using Stata software. RESULTS Of 1435 retrieved studies, 89 were reviewed in depth and 12 (8 prospective cohort and 4 population-based case-control studies) met the criteria for inclusion in a systematic review with 1,084,792 participants and 7015 cases of spontaneous miscarriage. Finally, 11 studies were included in the meta-analysis (one study was not included in the meta-analysis owing to methodological issues and low-quality score). Overall percentage of miscarriage in women who received antibiotics was 2.6%. After adjusting for important potential confounders, use of macrolides (RR: 1.42; 95% CI 1.04, 1.93), quinolones (RR: 2.48; 95% CI 1.46, 4.20), and tetracyclines (RR: 2.57; 95% CI 1.95, 3.38) during pregnancy were significantly associated with spontaneous miscarriage. In macrolides class, a significant positive association was found between clarithromycin and spontaneous miscarriage (RR: 1.98; 95% CI 1.46, 2.70). Sensitivity analysis demonstrated the consistency of the results, indicating that the meta-analysis model was robust. CONCLUSION Findings support a significant positive association between use of macrolides (especially clarithromycin), quinolones, and tetracyclines during pregnancy and spontaneous miscarriage, although it should be interpreted with caution in the context of limitations of the available data. REVIEW REGISTRATION International register for systematic reviews; PROSPEROCRD42018093465.
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12
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Damkier P, Brønniche LMS, Korch-Frandsen JFB, Broe A. In utero exposure to antibiotics and risk of congenital malformations: a population-based study. Am J Obstet Gynecol 2019; 221:648.e1-648.e15. [PMID: 31260651 DOI: 10.1016/j.ajog.2019.06.050] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 06/11/2019] [Accepted: 06/25/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Antibiotics are commonly prescribed during pregnancy. Although the safety of most penicillins is well established, some controversy and uncertainty are associated with the use of other commonly prescribed antibiotics. OBJECTIVE To determine the risk of congenital malformations following first-trimester in utero exposure to 10 commonly prescribed antibiotics in Denmark. MATERIALS AND METHODS This was a cohort study comprising all singleton liveborn children in Denmark between 2000 and 2015. Data on malformations were collected through 2016. Merging validated and comprehensive populationwide Danish healthcare and civic registries, we merged data on pregnancy, prescription drugs purchases during first trimester and congenital malformations. Using logistic regression, we calculated the odds ratio for congenital malformations (any), major congenital malformations, and cardiac congenital malformations for the 10 most commonly prescribed antibiotics (excluding 4 penicillins that served as control). In the primary analysis, the exposed cohort was compared to a cohort exposed to any of 4 penicillins considered safe during pregnancy (ampicillin, pivampicillin, benzylpenicillin, and phenoxymethylpenicillin). In sensitivity analysis, the exposed cohort was compared to an unexposed cohort. Covariate adjustments were made for maternal age at delivery, year of delivery, parity, pre-pregnancy body mass index, smoking, educational status, employment status, and annual personal income. RESULTS We found no increased risk of congenital malformations to be related to first-trimester in utero exposure to the 10 most commonly prescribed antibiotics in Denmark compared to a cohort of pregnant women exposed to penicillins that are considered safe during pregnancy. Compared to unexposed pregnancies, small increased risks for major malformations and cardiac malformations were apparent for pivmecillinam (odds ratio, 1.13; confidence interval, 1.06-1.19; and odds ratio, 1.15; confidence interval, 1.04-1.28, respectively), sulfamethizole (odds ratio, 1.15; confidence interval, 1.07-1.24; and odds ratio, 1.22; confidence interval, 1.07-1.39, respectively), and azithromycin (odds ratio, 1.19, confidence interval, 1.03-1.38; and odds ratio, 1.29, confidence interval, 0.99-1.67, respectively). CONCLUSION In this large populationwide cohort study, we found, with a high degree of precision, no increased risk of congenital malformations following first-trimester exposure to 10 commonly prescribed systemic antibiotics.
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Affiliation(s)
- Per Damkier
- Department of Clinical Biochemistry & Pharmacology, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
| | - Louise M S Brønniche
- Clinical Pharmacology & Pharmacy, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | | | - Anne Broe
- Department of Clinical Biochemistry & Pharmacology, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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13
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Menéndez R, Cantón R, García-Caballero A, Barberán J. [Three keys to the appropriate choice of oral antibiotic treatment in the respiratory tract infections]. REVISTA ESPANOLA DE QUIMIOTERAPIA : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE QUIMIOTERAPIA 2019; 32:497-515. [PMID: 31795630 PMCID: PMC6913073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 11/25/2019] [Indexed: 11/18/2022]
Abstract
Exacerbation of chronic obstructive pulmonary disease and community-acquired pneumonia are the most frequent infections of the lower respiratory tract in daily clinical practice. Antibiotic selection is a crucial component in its treatment and, in most cases, it is performed empirically. Scientific societies make therapeutic recommendations based on scientific evidence and / or expert recommendations that are of great help to clinicians. Beta-lactams, fluoroquinolones and macrolides are the most commonly used drugs for oral administration. From a practical point of view, there are three keys to the appropriate choice of oral antibiotic treatment, which are the effectiveness, safety and the ecological impact on the patient's microbiota, including the development of resistance, which will be assessed in depth in this review.
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Affiliation(s)
| | | | | | - J Barberán
- José Barberán, Servicio de Medicina Interna y Enfermedades infecciosas, Hospital Universitario HM Montepríncipe, Universidad San Pablo CEU. Madrid, Spain.
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Li S, Wang H, Hu H, Wu Z, Chen K, Mao Z. Effect of ambient air pollution on premature SGA in Changzhou city, 2013-2016: a retrospective study. BMC Public Health 2019; 19:705. [PMID: 31174511 PMCID: PMC6555963 DOI: 10.1186/s12889-019-7055-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 05/27/2019] [Indexed: 11/28/2022] Open
Abstract
Background Air pollution is becoming an increased burden to the world. Previous studies have confirmed its effects on adverse birth outcomes, but few associated with premature small for gestational age (SGA). We report a retrospective cohort study conducted in Changzhou city to evaluate the association between air pollutants (PM2.5, SO2 and NO2) and premature SGA during pregnancy. Methods A total of 46,224 births were collected from January, 2013 to December, 2016, in Changzhou Maternity and Child Health Care Hospital, finally 2709 preterm births were admitted for study. Corresponding air monitoring data were collected from Changzhou Environmental Protection Agency. Generalized estimating equations were used to examine the association between these air pollutants and premature SGA controlling for individual covariates in single- and multi-pollutant models. Results We found that, in the third trimester, every 10 μg/m3 increments in PM2.5 concentration were associated with premature SGA (OR = 1.18, 95% CI: 1.03–2.83; OR = 1.37, 95% CI: 1.03–3.58) in two- and three-pollutants models. In the whole gestation, a 10 μg/m3 increment in PM2.5 concentration in two- and three-pollutant models were related to premature SGA (OR = 1.53, 95% CI: 1.38–2.47; OR = 1.73, 95% CI: 1.18–2.57). The OR (95% CI) of premature SGA were increasing across quintiles of PM2.5, SO2, NO2 concentrations during the whole gestation period adjusting for confounders (Pfor trend < 0.001). Conclusions These results indicated that pregnant women exposed to PM2.5, combined with other pollutants in the third trimester have a higher risk to deliver premature SGA babies, providing further evidence linking PM2.5 and pregnancy outcomes.
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Affiliation(s)
- Shushu Li
- Changzhou Center for Disease Control and Prevention, Changzhou, 213022, Jiangsu, China
| | - Huaiyan Wang
- Changzhou Maternity and Child Health Care Hospital affiliated to Nanjing Medical University, Changzhou, 213003, Jiangsu, China
| | - Haiting Hu
- Changzhou Maternity and Child Health Care Hospital affiliated to Nanjing Medical University, Changzhou, 213003, Jiangsu, China
| | - Zeying Wu
- Changzhou Institute of Technology, Changzhou, 213003, Jiangsu, China
| | - Kejin Chen
- Changzhou Maternity and Child Health Care Hospital affiliated to Nanjing Medical University, Changzhou, 213003, Jiangsu, China
| | - Zhilei Mao
- Changzhou Maternity and Child Health Care Hospital affiliated to Nanjing Medical University, Changzhou, 213003, Jiangsu, China. .,State Key Laboratory of Reproductive Medicine, Center for Global Health, Nanjing Medical University, 101 Longmian Road, Nanjing, 211100, China. .,Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, 101 Longmian Road, Nanjing, 211100, China.
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15
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Sarwar A. Drugs in renal disease and pregnancy. Best Pract Res Clin Obstet Gynaecol 2019; 57:106-119. [PMID: 31031053 DOI: 10.1016/j.bpobgyn.2019.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 11/12/2018] [Accepted: 03/27/2019] [Indexed: 01/06/2023]
Abstract
This review aims to summarise historic and the latest evidence of commonly used drugs in pregnant women with chronic kidney disease (CKD). Data regarding safety of drugs in breastfeeding are also described. Practical recommendations are made on the use of newer agents that have limited information of use in pregnant women with CKD. Pharmacokinetic and dynamic issues are outlined, and general principles for prescribing drugs in pregnant women with CKD are listed. Resources to investigate drug safety are presented.
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Affiliation(s)
- Asif Sarwar
- Advanced Clinical Pharmacist - Electronic Prescribing, Pharmacy Department, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, B15 2TH, England, United Kingdom.
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16
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Acar S, Keskin-Arslan E, Erol-Coskun H, Kaya-Temiz T, Kaplan YC. Pregnancy outcomes following quinolone and fluoroquinolone exposure during pregnancy: A systematic review and meta-analysis. Reprod Toxicol 2019; 85:65-74. [DOI: 10.1016/j.reprotox.2019.02.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 02/01/2019] [Accepted: 02/06/2019] [Indexed: 11/16/2022]
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17
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Tang ASO, Yeo ST, Teh YC, Kho WM, Chew LP, Muniandy P. The mystery of 'saturation gap': a case of dapsone-induced methaemoglobinemia in a pregnant mother with leprosy. Oxf Med Case Reports 2019; 2019:omy111. [PMID: 30697428 PMCID: PMC6345088 DOI: 10.1093/omcr/omy111] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 09/15/2018] [Accepted: 10/17/2018] [Indexed: 11/14/2022] Open
Abstract
Limited data regarding methemoglobinemia in pregnancy, particularly secondary to dapsone is available up to date. We report a case of dapsone-induced methemoglobinemia in a pregnant mother with multibacillary leprosy who presented with fever, productive cough and cyanosis of 2 days duration 2 weeks after multidrug therapy was commenced. On examination, she had central cyanosis with low oxygen saturation (SpO2 = 84–88%). Arterial blood gas analysis showed PO2 of 111 mmHg and SO2 of 98 mmHg. Patient was administered 100% oxygen inhalation, but there was no improvement in cyanosis. Vitamin C (1000 mg/day) was prescribed. Dapsone was replaced by ofloxacin 200 mg twice daily. There was a gradual increase in SpO2 level. She delivered a healthy baby. In conclusion, clinicians should be aware of the side effects of dapsone and know how to promptly manage any undesirable events. Ofloxacin is a safe and feasible alternative in replacement of dapsone in pregnancy.
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Affiliation(s)
| | - Siaw Tze Yeo
- Medical Department, Miri General Hospital, Sarawak, Malaysia
| | - Yeon Chiat Teh
- Medical Department, Miri General Hospital, Sarawak, Malaysia
| | - Wee Meng Kho
- Dermatology Unit, Department of Internal Medicine, Sarawak General Hospital, Sarawak, Malaysia
| | - Lee Ping Chew
- Haematology Unit, Department of Internal Medicine, Sarawak General Hospital, Sarawak, Malaysia
| | - Pubalan Muniandy
- Dermatology Unit, Department of Internal Medicine, Sarawak General Hospital, Sarawak, Malaysia
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18
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Ziv A, Masarwa R, Perlman A, Ziv D, Matok I. Pregnancy Outcomes Following Exposure to Quinolone Antibiotics – a Systematic-Review and Meta-Analysis. Pharm Res 2018; 35:109. [DOI: 10.1007/s11095-018-2383-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Accepted: 03/04/2018] [Indexed: 10/17/2022]
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19
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Yefet E, Schwartz N, Chazan B, Salim R, Romano S, Nachum Z. The safety of quinolones and fluoroquinolones in pregnancy: a meta-analysis. BJOG 2018; 125:1069-1076. [DOI: 10.1111/1471-0528.15119] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2017] [Indexed: 12/01/2022]
Affiliation(s)
- E Yefet
- Department of Obstetrics & Gynecology; Emek Medical Center; Afula Israel
| | - N Schwartz
- Research Authority and Biostatistics; Emek Medical Center; Afula Israel
| | - B Chazan
- Infectious Disease Unit; Emek Medical Center; Afula Israel
- Rappaport Faculty of Medicine; Technion; Haifa Israel
| | - R Salim
- Department of Obstetrics & Gynecology; Emek Medical Center; Afula Israel
- Rappaport Faculty of Medicine; Technion; Haifa Israel
| | - S Romano
- Department of Obstetrics & Gynecology; Emek Medical Center; Afula Israel
- Rappaport Faculty of Medicine; Technion; Haifa Israel
| | - Z Nachum
- Department of Obstetrics & Gynecology; Emek Medical Center; Afula Israel
- Rappaport Faculty of Medicine; Technion; Haifa Israel
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20
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Muanda F, Sheehy O, Berard A. Reply to 'Comment on "Use of antibiotics during pregnancy and the risk of major congenital malformations: a population based cohort study" by Muanda et al.'. Br J Clin Pharmacol 2018; 84:1083-1084. [PMID: 29460401 DOI: 10.1111/bcp.13528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 01/14/2018] [Accepted: 01/16/2018] [Indexed: 11/26/2022] Open
Affiliation(s)
- Flory Muanda
- University of Montreal, Faculty of Pharmacy, Montréal, Canada.,CHU Sainte-Justine Research Center, Montréal, Canada
| | - Odile Sheehy
- CHU Sainte-Justine Research Center, Montréal, Canada
| | - Anick Berard
- University of Montreal, Faculty of Pharmacy, Montréal, Canada.,CHU Sainte-Justine Research Center, Montréal, Canada
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21
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Dogan Z, Cetin A, Elibol E, Vardi N, Turkoz Y. Effects of ciprofloxacin and quercetin on fetal brain development: a biochemical and histopathological study. J Matern Fetal Neonatal Med 2018; 32:1783-1791. [PMID: 29241384 DOI: 10.1080/14767058.2017.1418222] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE Teratogens cause birth defects and malformations while human development is being completed. In pregnancy, urinary tract infection (UTI) is a common health problem caused by bacteria. The fluoroquinolones such as ciprofloxacin, levofloxacin, moxifloxacin, and gemifloxacin can treat various types of bacterial infections successfully. The aim of this study is to determine whether the use of ciprofloxacin during pregnancy causes oxidative stress on brain tissues of the fetus, and whether quercetin contributes to prevent this damage if stress has already occurred. MATERIALS AND METHODS In our study, 22 young female Wistar albino rats weighing 250 g were used. Rats were mated overnight in separate plastic cages. Female rats were regarded as pregnant when a vaginal plug was observed, and these were divided into four groups of control, ciprofloxacin, quercetin, and cipro + quercetin. Two daily i.p. 20 mg/kg doses of ciprofloxacin were administered to ciprofloxacin group between 7 and 17 d of pregnancy. Throughout the study, daily (20 d) 20 mg/kg quercetin was dissolved in corn oil and administered to the quercetin group by oral gavage. Rats were fed ad libitum throughout the study. Fetuses were taken by C-section on the 20th day of pregnancy. Thereafter, the brain tissues were subjected to histological assessments and biochemical analyzes. RESULTS The experimental groups were compared with the control group; ciprofloxacin affected fetal development, especially caused damage to neurons in brain tissue and cause hemorrhagic defects. And also, it was determined that many parameters were affected such as antioxidant parameters, enzyme levels and levels of malondialdehyde (MDA) (a marker of lipid peroxidation). Quercetin is a member of flavonoid with strong antioxidant properties, and our results indicate that the use of ciprofloxacin in pregnancy can result damage to fetal brain tissue. CONCLUSIONS Unlike these results when some parameters are evaluated it is understood that this harmful effects suppressed by quercetin.
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Affiliation(s)
- Zumrut Dogan
- a Department of Anatomy, Faculty of Medicine , Adiyaman University , Adiyaman , Turkey
| | - Aymelek Cetin
- b Department of Anatomy, Faculty of Medicine , Inonu University , Malatya , Turkey
| | - Ebru Elibol
- c Department of Histology and Embryology, Faculty of Medicine , Adiyaman University , Adiyaman , Turkey
| | - Nigar Vardi
- d Department of Histology and Embryology, Faculty of Medicine , Inonu University , Malatya , Turkey
| | - Yusuf Turkoz
- e Department of Biochemistry, Faculty of Medicine , Inonu University , Malatya , Turkey
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22
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A Case of Macrolide-Refractory Mycoplasma pneumoniae Pneumonia in Pregnancy Treated with Garenoxacin. Case Rep Obstet Gynecol 2017; 2017:3520192. [PMID: 29375919 PMCID: PMC5742429 DOI: 10.1155/2017/3520192] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 11/20/2017] [Indexed: 11/18/2022] Open
Abstract
Pneumonia in pregnancy is associated with adverse maternal and foetal outcomes, and intensive treatment with appropriate antibiotics is essential. However, cases caused by pathogens that are resistant to antibiotics suitable for the developing foetus are challenging. We herein report a case of macrolide-refractory Mycoplasma pneumoniae pneumonia in pregnancy. A 40-year-old multigravida with twin pregnancy complained of cough and fever at 13 weeks of gestation and was diagnosed with pneumonia. Even though empiric treatment with ceftriaxone and oral azithromycin was started, her condition deteriorated rapidly. The findings of chest computed tomography suggested Mycoplasma pneumoniae pneumonia. Since azithromycin did not work, this strain was considered to be macrolide-refractory. Garenoxacin, an oral quinolone, was selected and was dramatically effective. The use of quinolone could be justified with the emergence of drug-resistant bacterial/atypical pneumonia and in the maternal life-threatening condition.
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23
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Muanda FT, Sheehy O, Bérard A. Use of antibiotics during pregnancy and the risk of major congenital malformations: a population based cohort study. Br J Clin Pharmacol 2017; 83:2557-2571. [PMID: 28722171 DOI: 10.1111/bcp.13364] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 06/12/2017] [Accepted: 06/14/2017] [Indexed: 02/01/2023] Open
Abstract
AIMS Few studies have investigated the link between individual antibiotics and major congenital malformations (MCMs) including specific malformations owing to small sample size. We aimed to quantify the association between exposure to gestational antibiotic and the risk of MCMs. METHODS Using the Quebec pregnancy cohort (1998-2008), we included a total of 139 938 liveborn singleton alive whose mothers were covered by the "Régie de l'assurance maladie du Québec" drug plan for at least 12 months before and during pregnancy. Antibiotic exposure was assessed in the first trimester and MCMs were identified within the first year of life. RESULTS After adjusting for potential confounders, clindamycin exposure was associated with an increased risk of MCMs (aOR 1.34, 95% CI 1.02-1.77, 60 exposed cases), musculoskeletal system malformations (aOR 1.67, 95% CI 1.12-2.48, 29 exposed cases) and ventricular/atrial septal defect (aOR 1.81, 95% CI 1.04-3.16, 13 exposed cases). Doxycycline exposure increased the risk of circulatory system malformation, cardiac malformations and ventricular/atrial septal defect (aOR 2.38, 95% CI 1.21-4.67, 9 exposed cases; aOR 2.46, 95% CI 1.21-4.99, 8 exposed cases; aOR 3.19, 95% CI 1.57-6.48, 8 exposed cases, respectively). Additional associations were seen with quinolone (1 defect), moxifloxacin (1 defect), ofloxacin (1 defect), macrolide (1 defect), erythromycin (1 defect) and phenoxymethylpenicillin (1 defect). No link was observed with amoxicillin, cephalosporins and nitrofurantoin. Similar results were found when penicillins were used as the comparator group. CONCLUSIONS Clindamycin, doxycycline, quinolones, macrolides and phenoxymethylpenicillin in utero exposure were linked to organ-specific malformations. Amoxicillin, cephalosporins and nitrofurantoin were not associated with MCMs.
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Affiliation(s)
- Flory T Muanda
- Faculty of Pharmacy, University of Montreal, Montréal, Québec, Canada.,Research Center, CHU Sainte-Justine, Montréal, Québec, Canada
| | - Odile Sheehy
- Research Center, CHU Sainte-Justine, Montréal, Québec, Canada
| | - Anick Bérard
- Faculty of Pharmacy, University of Montreal, Montréal, Québec, Canada.,Research Center, CHU Sainte-Justine, Montréal, Québec, Canada
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24
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Muanda FT, Sheehy O, Bérard A. Use of antibiotics during pregnancy and risk of spontaneous abortion. CMAJ 2017; 189:E625-E633. [PMID: 28461374 DOI: 10.1503/cmaj.161020] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2017] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Although antibiotics are widely used during pregnancy, evidence regarding their fetal safety remains limited. Our aim was to quantify the association between antibiotic exposure during pregnancy and risk of spontaneous abortion. METHODS We conducted a nested case-control study within the Quebec Pregnancy Cohort (1998-2009). We excluded planned abortions and pregnancies exposed to fetotoxic drugs. Spontaneous abortion was defined as having a diagnosis or procedure related to spontaneous abortion before the 20th week of pregnancy. The index date was defined as the calendar date of the spontaneous abortion. Ten controls per case were randomly selected and matched by gestational age and year of pregnancy. Use of antibiotics was defined by filled prescriptions between the first day of gestation and the index date and was compared with (a) non-exposure and (b) exposure to penicillins or cephalosporins. We studied type of antibiotics separately using the same comparator groups. RESULTS After adjustment for potential confounders, use of azithromycin (adjusted odds ratio [OR] 1.65, 95% confidence interval [CI] 1.34-2.02; 110 exposed cases), clarithromycin (adjusted OR 2.35, 95% CI 1.90-2.91; 111 exposed cases), metronidazole (adjusted OR 1.70, 95% CI 1.27-2.26; 53 exposed cases), sulfonamides (adjusted OR 2.01, 95% CI 1.36-2.97; 30 exposed cases), tetracyclines (adjusted OR 2.59, 95% CI 1.97-3.41; 67 exposed cases) and quinolones (adjusted OR 2.72, 95% CI 2.27-3.27; 160 exposed cases) was associated with an increased risk of spontaneous abortion. Similar results were found when we used penicillins or cephalosporins as the comparator group. INTERPRETATION After adjustment for potential confounders, use of macro-lides (excluding erythromycin), quinolones, tetracyclines, sulfonamides and metronidazole during early pregnancy was associated with an increased risk of spontaneous abortion. Our findings may be of use to policy-makers to update guidelines for the treatment of infections during pregnancy.
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Affiliation(s)
- Flory T Muanda
- Faculty of Pharmacy (Muanda, Bérard), Université de Montréal; Research Center (Muanda, Sheehy, Bérard), Centre hospitalier universitaire (CHU) Sainte-Justine, Montréal, Que
| | - Odile Sheehy
- Faculty of Pharmacy (Muanda, Bérard), Université de Montréal; Research Center (Muanda, Sheehy, Bérard), Centre hospitalier universitaire (CHU) Sainte-Justine, Montréal, Que
| | - Anick Bérard
- Faculty of Pharmacy (Muanda, Bérard), Université de Montréal; Research Center (Muanda, Sheehy, Bérard), Centre hospitalier universitaire (CHU) Sainte-Justine, Montréal, Que.
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26
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Cavusoglu I, Kadioglu M, Erkoseoglu I, Aran T, Osmanagaoglu M, Yenilmez E, Kesim S, Kalyoncu M, Aykan D, Yaris E, Kalyoncu N. Evaluation of teratogenic effects of ciprofloxacin in pregnant women exposed due to urinary tract infections. Reprod Toxicol 2016. [DOI: 10.1016/j.reprotox.2016.03.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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27
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Jovelet C, Broutin S, Gil S, Mir O, Paci A. [Tyrosine kinase inhibitors and pregnancy: A risk to the fetus?]. Bull Cancer 2016; 103:478-83. [PMID: 26969425 DOI: 10.1016/j.bulcan.2016.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 01/22/2016] [Accepted: 02/08/2016] [Indexed: 02/09/2023]
Abstract
The association of cancer and pregnancy is increasingly frequent. This is related, partially, to the increasingly belated age of pregnancy. The management of cancer in pregnancy is a complicated issue. The use of tyrosine kinase inhibitors (TKIs) during pregnancy remains rare and only few data are available concerning their transplacental passage. The aim of this work is to review the data described in the literature, in order to highlight the risks incurred by the fetus, associated with these TKIs' treatment. Up to 189 pregnancies of women treated with TKIs during part or throughout their pregnancy have been described. Clinical data are reassuring and would be in favor of taking the treatment in terms of the balance maternal profit versus fetal risk. These data must, nevertheless, be interpreted with caution.
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Affiliation(s)
- Cécile Jovelet
- Gustave-Roussy, laboratoire de recherche translationnelle, 114, rue Edouard-Vaillant, 94805 Villejuif, France
| | - Sophie Broutin
- Gustave-Roussy, service de pharmacologie et d'analyse du médicament, 114, rue Edouard-Vaillant, 94805 Villejuif cedex, France
| | - Sophie Gil
- Université Paris Descartes, Inserm, UMR-S 1139, 4, avenue de l'Observatoire, 75006 Paris, France
| | - Olivier Mir
- Université Paris Sud, Gustave-Roussy, département de médecine oncologique, 114, rue Edouard-Vaillant, 94805 Villejuif, France
| | - Angelo Paci
- Gustave-Roussy, service de pharmacologie et d'analyse du médicament, 114, rue Edouard-Vaillant, 94805 Villejuif cedex, France.
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Nordeng S, Nordeng H, Høye S. [Use of antibiotics during pregnancy]. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2016; 136:317-21. [PMID: 26905846 DOI: 10.4045/tidsskr.15.0451] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Antibiotics are the most widely used medication on prescription in pregnancy. It is therefore important to investigate whether antibiotic use in pregnancy can harm the foetus. During the last decade the availability of data from national registries has made it possible to conduct large-scale epidemiological studies. In this article we aimed to review recent studies on the risk of congenital anomalies and miscarriage resulting from the use of antibiotics in pregnancy. METHOD A literature search was conducted in MedLine, Embase and PubMed for the period 1 December 2005-1 December 2015. We identified 1,316 articles, of which 23 met the inclusion criteria. RESULTS Recent epidemiological studies have focused on investigating the risks of malformations and pyloric stenosis after exposure to macrolides, nitrofurantoin, penicillins and trimethoprim-sulphamethoxazole. In nine of ten studies that included in total more than 38,000 patients exposed to macrolides, and two studies with more than 7,000 exposed to nitrofurantoin, no significantly increased risk of malformations was discovered. There are some contradictory findings for certain groups of antibiotics with regard to the risk of miscarriage, heart defects and pyloric stenosis. INTERPRETATION Recent studies indicate that erythromycin and nitrofurantoin can be used as second-line drugs in the first trimester. The results from recent studies concur with the recommendations for pregnant women in national guidelines regarding antibiotic use in the primary health service.
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Affiliation(s)
| | - Hedvig Nordeng
- Pharmacoepidemiology and Drug Safety Research Group (PharmaSafe) Farmasøytisk institutt Det matematisk-naturvitenskapelige fakultet Universitetet i Oslo
| | - Sigurd Høye
- Antibiotikasenteret for primærmedisin Avdeling for allmennmedisin Institutt for helse og samfunn Det medisinske fakultet Universitetet i Oslo
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Rocha-Castro J, Kronbauer K, Dallé J, Jimenez MF, Riche CW, Santiago JA, Antonello VS. Characteristics of bacterial acute diarrhea among women. Int J Gynaecol Obstet 2015; 132:302-4. [PMID: 26674319 DOI: 10.1016/j.ijgo.2015.07.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 07/14/2015] [Accepted: 11/17/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To describe the clinical and microbiological characteristics of women presenting with acute gastroenteritis due to infection with Salmonella spp. or Shigella spp. METHODS A cross-sectional retrospective study was conducted using data for patients with specimens positive for Shigella spp. and Salmonella spp. attending two major women's hospitals in Porto Alegre, Brazil, between January 2003 and July 2014. Women were included if they had symptoms compatible with bacterial acute diarrhea. Isolates were evaluated to determine antimicrobial susceptibility and patient clinical profile. RESULTS Among 45 eligible patients, Salmonella spp. was identified in 32 (71%) and Shigella spp. in 13 (29%). The highest antimicrobial sensitivity rates were observed for ciprofloxacin and ceftriaxone (n=44, 98% for both) whereas the greatest resistance rate was seen for ampicillin (n=20, 44%). Seven (16%) of the women were pregnant. CONCLUSION Ciprofloxacin, ceftriaxone, and sulfamethoxazole/trimethoprim are suitable choices for the treatment of bacterial acute diarrhea. However, the maternal and fetal safety profile of prescribed medications should be considered when treating pregnant patients.
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Affiliation(s)
- Juliane Rocha-Castro
- Department of Gynecology and Obstetrics, Hospital Fêmina, Porto Alegre, Brazil; Post-Graduate Program in Pathology, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
| | - Karoline Kronbauer
- Department of Prevention and Infection Control, Hospital Fêmina, Porto Alegre, Brazil
| | - Jessica Dallé
- Department of Prevention and Infection Control, Hospital Fêmina, Porto Alegre, Brazil
| | - Mirela F Jimenez
- Department of Gynecology and Obstetrics, Hospital Fêmina, Porto Alegre, Brazil; Post-Graduate Program in Pathology, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil; Department of Gynecology and Obstetrics, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
| | - Cezar W Riche
- Department of Prevention and Infection Control, Hospital Nossa Senhora da Conceição, Porto Alegre, Brazil
| | - Jorge A Santiago
- Department of Microbiology, Hospital Nossa Senhora da Conceição, Porto Alegre, Brazil
| | - Vicente S Antonello
- Department of Prevention and Infection Control, Hospital Fêmina, Porto Alegre, Brazil.
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Sadiq MA, Hassan M, Agarwal A, Sarwar S, Toufeeq S, Soliman MK, Hanout M, Sepah YJ, Do DV, Nguyen QD. Endogenous endophthalmitis: diagnosis, management, and prognosis. J Ophthalmic Inflamm Infect 2015; 5:32. [PMID: 26525563 PMCID: PMC4630262 DOI: 10.1186/s12348-015-0063-y] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Accepted: 10/28/2015] [Indexed: 02/08/2023] Open
Abstract
Endogenous endophthalmitis is an ophthalmic emergency that can have severe sight-threatening complications. It is often a diagnostic challenge because it can manifest at any age and is associated with a number of underlying predisposing factors. Microorganisms associated with this condition vary along a broad spectrum. Depending upon the severity of the disease, both medical and surgical interventions may be employed. Due to rarity of the disease, there are no guidelines in literature for optimal management of these patients. In this review, treatment guidelines based on clinical data and microorganism profile have been proposed.
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Affiliation(s)
- Mohammad Ali Sadiq
- Ocular Imaging Research and Reading Center, Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center, 3902 Leavenworth Street, Omaha, NE, 68105, USA.
| | - Muhammad Hassan
- Ocular Imaging Research and Reading Center, Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center, 3902 Leavenworth Street, Omaha, NE, 68105, USA.
| | - Aniruddha Agarwal
- Ocular Imaging Research and Reading Center, Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center, 3902 Leavenworth Street, Omaha, NE, 68105, USA.
| | - Salman Sarwar
- Ocular Imaging Research and Reading Center, Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center, 3902 Leavenworth Street, Omaha, NE, 68105, USA.
| | - Shafak Toufeeq
- Ocular Imaging Research and Reading Center, Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center, 3902 Leavenworth Street, Omaha, NE, 68105, USA.
| | - Mohamed K Soliman
- Ocular Imaging Research and Reading Center, Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center, 3902 Leavenworth Street, Omaha, NE, 68105, USA. .,Department of Ophthalmology, Assiut University Hospital, Assiut University, Assiut, Egypt.
| | - Mostafa Hanout
- Ocular Imaging Research and Reading Center, Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center, 3902 Leavenworth Street, Omaha, NE, 68105, USA.
| | - Yasir Jamal Sepah
- Ocular Imaging Research and Reading Center, Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center, 3902 Leavenworth Street, Omaha, NE, 68105, USA.
| | - Diana V Do
- Ocular Imaging Research and Reading Center, Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center, 3902 Leavenworth Street, Omaha, NE, 68105, USA.
| | - Quan Dong Nguyen
- Ocular Imaging Research and Reading Center, Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center, 3902 Leavenworth Street, Omaha, NE, 68105, USA.
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Kaplan YC, Karadaş B, Kaya-Temiz T. Defining a medication class as a teratogen: may the evidence be with you and not the FDA Pregnancy Risk Categories. Acad Emerg Med 2015; 22:769. [PMID: 25999059 DOI: 10.1111/acem.12691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Yusuf Cem Kaplan
- Terafar - Izmir Katip Celebi University Teratology Information; Training and Research Center; Karabağlar İzmir Türkiye
| | - Barış Karadaş
- Terafar - Izmir Katip Celebi University Teratology Information; Training and Research Center; Karabağlar İzmir Türkiye
| | - Tijen Kaya-Temiz
- Terafar - Izmir Katip Celebi University Teratology Information; Training and Research Center; Karabağlar İzmir Türkiye
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Wacker E, Navarro A, Meister R, Padberg S, Weber-Schoendorfer C, Schaefer C. Does the average drug exposure in pregnant women affect pregnancy outcome? A comparison of two approaches to estimate the baseline risks of adverse pregnancy outcome. Pharmacoepidemiol Drug Saf 2015; 24:353-60. [PMID: 25644395 DOI: 10.1002/pds.3744] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 10/24/2014] [Accepted: 12/08/2014] [Indexed: 11/09/2022]
Abstract
PURPOSE The results of observational cohort studies on drug effects on pregnancy outcome may depend among others on suitable comparison cohorts. The aim of this investigation was to compare two distinct definitions of maternal exposure status for comparison cohorts. METHODS We performed an observational cohort study of prospectively ascertained pregnant women who spontaneously contacted the Teratology Information Service (TIS) Berlin for drug risk consultation. The only exclusion criteria were exposures to established teratogens and/or fetotoxicants. Pregnancy outcomes of 3250 women with this "average drug exposure" were compared with 546 non-exposed or insignificantly exposed pregnancies. RESULTS Neither the rate of major birth defects (3.0%; aOR 1.62; 95% CI 0.8-3.3) nor the risk of spontaneous abortion (16.0%; aHR 1.20; 95% CI 0.8-1.7) was significantly increased after average drug exposure, whereas the rate of electively terminated pregnancies was higher (11.1%; aHR 2.05; 95% CI 1.2-3.4). There were no differences in the risk of preterm birth (9.9%; aOR 1.38; 95% CI 0.9-2.0) and infants' birth weight (p = 0.60). CONCLUSIONS This study does not provide evidence for an increased risk of adverse pregnancy outcome after average drug exposure during pregnancy. Therefore, comparison cohorts with average drug exposure are appropriate for studies on potential teratogens or fetotoxicants based on observational data collected by TIS.
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Affiliation(s)
- Evelin Wacker
- Pharmakovigilanz- und Beratungszentrum für Embryonaltoxikologie (Institute for Clinical Teratology and Drug Risk Assessment in Pregnancy), Charité Universitätsmedizin Berlin, Berlin, Germany
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Padberg S. Anti-infective Agents. DRUGS DURING PREGNANCY AND LACTATION 2015. [PMCID: PMC7150338 DOI: 10.1016/b978-0-12-408078-2.00007-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/29/2022]
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