ling
Forum Senior
Topics: 23
Posts: 46
|
. A 19-year-old primigravid woman at 34 weeks' gestation comes to the physician for a routine prenatal visit. Her pregnancy has been uncomplicated. She has no history of serious illness. She takes no medications and has no known allergies. Examination shows a uterus consistent in size with a 34-week gestation. A routine clean-catch urine culture grows greater than 100,000 colonies/mL of Escherichia coli. Which of the following is the most appropriate pharmacotherapy?
A
) Ampicillin
B
) Ciprofloxacin
C
) Clindamycin
D
) Doxycycline
E
) Trimethoprim-sulfamethoxazole
|
| robin082006
Forum Hero
Topics: 471
Posts: 5,123
|
A--> Ampicillin
___________________
The Key to Succeed is Patience.
|
| damngood
Forum Newbie
Topics: 0
Posts: 79
|
is it not
tmp--smx
|
| maiya
Forum Newbie
Topics: 3
Posts: 35
|
damngood wrote:
is it not
tmp--smx
Trimethoprim-sulfamethoxazole is a teratogen, as it interferes with folic acid metabolism...of course, at 34 weeks, is the same concern?
i too chose Ampicillin, as it's a safer bet, at least i thought so.
any thoughts?
...i found this on the internet (and so the answer to this question is in fact Ampicillin):
Trimethoprim and Sulfonamides
Trimethoprim is in category C. There is very little placental transfer of the drug, but it is generally avoided because it inhibits folic acid metabolism, as does methotrexate, which is a known teratogen.[7] Pyrimethamine is also avoided because it has the same mechanism of action.
Sulfonamides are category B but should be avoided near the end of gestation (third trimester) because of the increased risk of kernicterus in the infant. Kernicterus is thought to occur when the sulfonamide competes with bilirubin for albumin binding, thus causing hyperbilirubinemia.[7] The free bilirubin diffuses into the central nervous system.[2] The placenta can clear unconjugated bilirubin, but once the infant is born, it has no elimination mechanism.[2] Infants with glucose-6-phosphate deficiency (G6PD) can develop hemolytic anemia if the mother takes sulfonamides late in pregnancy.[23] At high doses, gross fetal malformations have been reported in animals,[24] but in humans only 2 studies suggest an association between these drugs and birth defects.[25,26]
Trimethoprim/sulfamethoxazole (TMP/SMX) is not recommended because it is a combination product[7]; however, sulfa drugs can be used when necessary during the first or second trimesters.
Edited by maiya on 03/27/07 - 07:21 AM
|
| Justice
Forum Fanatic
Topics: 117
Posts: 2,324
|
I would not be concerned about FA at 34 weeks of gestation, and give (E)
___________________
Don't live in a town where there are no doctors
|
| ram3
Forum Guru
Topics: 48
Posts: 525
|
Ampicillin
|
| eckimazuro
Forum Newbie
Topics: 2
Posts: 15
|
E is a class C drug, ampicillin a class B drug, thus less risky. Give ampicillin.
|
| kavi
Forum Newbie
Topics: 4
Posts: 18
|
agree with ampicillin less risky and she has no drug allergies
|
| doc_clotaire
Forum Guru
Topics: 159
Posts: 1,274
|
The best antibiotic asymptomatic UTI antibiotic for pregnant woman are :
Ampicillin and Nitrofurantoin
___________________
The elevator to succes is broke ,you must take the stairs
|
| klimt
Forum Guru
Topics: 27
Posts: 605
|
agree with doc_clotaire. I would also add first gen cephalosporins to the UTI safe-drug list
___________________
Traveler, there are no roads. Roads are made by walking.
|
| ram3
Forum Guru
Topics: 48
Posts: 525
|
Ampicillin Big Time
|
| hanwin
Forum Senior
Topics: 6
Posts: 157
|
Ampicillin
|
|
| |
| | | | | | | | | | | | |
