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Pregnancy and lower urinary tract infection: opt for cefuroxime

Requiring just a single dose, fosfomycin trometamol is easier to take than cefuroxime or the combination of amoxicillin + clavulanic acid, but less is known about its short-term effects on the unborn child exposed during the first trimester of pregnancy. It is wiser to choose cefuroxime as first-line treatment.

Minor lower urinary tract infections are frequent during pregnancy.  They are routinely treated because they are a risk factor for premature birth. The first-choice antibiotics are cefuroxime and the combination of amoxicillin + clavulanic acid, because a large amount of data on short-term exposure is available. This includes around 400 pregnancies exposed from the first trimester to cefuroxime, and 500 exposed to the combination of amoxicillin + clavulanic acid, in which no problem was identified.

In mid-2017, proprietary drugs based on single-dose fosfomycin trometamol were authorised in France for urinary tract infections in pregnant women, after having been recommended by a range of institutions. This recommendation was based on a few clinical trials which showed similar efficacy to that of standard antibiotic treatment.

Fosfomycin trometamol crosses the placenta and is widely distributed in the body. During the first trimester, assessment of the consequences for the unborn child of exposure to fosfomycin trometamol is based on around 150 pregnancies. No worrying safety alert has appeared, but these data are too few in number to exclude a significant risk. It is wiser to choose cefuroxime as first-line treatment.

©Prescrire 1 April 2019

"Fosfomycin trometamol for pregnant women: many unknowns" Prescrire Int 2019; 28 (203): 96-98. (Pdf, subscribers only).

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