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- Presentation
Treatment of Infections and Infestations in the Pregnant Patient
Description
Dr. Jenny Murassi discussed the treatment of infections and infestations in pregnant patients at a recent seminar. She emphasized the necessity of understanding the care requirements of women with chronic conditions, noting that many do not disclose their pregnancies. The talk was structured around four key categories: bacterial infections, fungal infections, viral infections, and infestations. For bacterial infections, treatments like mupirocin, first-generation cephalosporins, and clindamycin are recommended, with an emphasis on non-medication interventions when possible. Fungal infections can be managed with topical agents such as clotrimazole and ketoconazole, while systemic antifungals like fluconazole are generally not advisable due to potential fetal risks. For viral infections like herpes, acyclovir is the preferred treatment, and preventive measures are highlighted for those with genital herpes planning vaginal delivery. In discussing infestations, Dr. Murassi advocated for permethrin and other low-risk options, including sulfur ointments. The importance of using culture sensitivities for antibiotic choice and preferring non-pharmacological treatments when feasible was stressed. Emphasizing the safety profiles of various medications during pregnancy, the presentation culminated in practical recommendations and resources for healthcare providers, promoting informed care for pregnant women and those of childbearing age.
View moreConclusions
- Topical mupirocin and first-generation cephalosporins are safe first-line treatments for impetigo in pregnant patients.
- For cellulitis, oral or IV penicillin and dicloxacillin are the preferred choices, depending on sensitivity.
- Clindamycin is the first-line treatment for MRSA infections during pregnancy.
- It is preferable to treat abscesses without antibiotics unless specific criteria are met.
- Macrolides like erythromycin are preferred for bacterial infections, but careful consideration of potential risks is necessary.
- Clindamycin is considered a safe antibiotic during pregnancy, but susceptibility testing is important.
- Topical antifungal agents like clotrimazole and miconazole are safe for treating tinea corporis and candidiasis during pregnancy.
- Systemic antifungals such as fluconazole are not advised due to potential risks for congenital defects.
- Acyclovir is the treatment of choice for herpes simplex virus during pregnancy, with famciclovir and valaciclovir considered likely safe.
- Liquid nitrogen is recommended for treating HPV-related conditions, while podophyllin is contraindicated.
- Permethrin is the preferred treatment for scabies, while alternatives like ivermectin and precipitated sulfur have varying levels of effectiveness and safety.
- Communication with patients about medication safety preconception is critical as many pregnancies are not disclosed at initiation.
- J Antimicrob Chemother. 2008 Jul;62(1):172-6
- International Journal of Women's Dermatology 6 (2020) 142-151
- October 2024 Journal of the American Academy of Dermatology CME Safety of dermatologic medications in pregnancy and lactation. Yaghi M/McMullan P, Rothe M, Grant-Kels J, Murase JE.