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 Question discrepancy  



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Author8 Posts
  #1

I'm in a dilemma.....USMLE World question says TMP-SMX is not to be used for UTI's in pregnancy because it causes fetal kernicterus, should use nitrofurantoin instead. Kaplan says use TMP-SMX and in real life we only use TMP-SMX. How would you answer this question!!!




  #2

It depends on the stage of pregnancy. Last trimester TMP-SMX not really recomended since and if the baby is born, his or her liver has to breakdown TMP-SMX. A young liver will have difficulty breaking it down and there could be kernicterus. Therefore nitrofurantoin is recomended and use frequently through out the pregnancy. But TMP-SMX can be used early in pregnancy.


  #3

The patient is 16 weeks pregnant....how would you answer the Q on the USMLE knowing patient is 16 weeks?
Thanks for the response.


  #4

is Nitrofurantoin is in the FDA pregnancy category B. This means that it not likely to harm an unborn baby. However, nitrofurantoin should not be taken by pregnant women who are at term (38-42 weeks gestation), during labor and delivery, or when the onset of labor is imminent.
Nitrofurantoin, ampicillin, and the cephalosporins have been considered relatively safe in early pregnancy. Sulfonamides should be avoided in the first trimester because of possible teratogenic effects and avoided near term because of a possible role in the development of kernicterus. Trimethoprim is usually avoided because of evidence of fetal toxicity at high doses in animals, although it has been used successfully in humans during pregnancy without evidence of toxicity or teratogenicity. Fluoroquinolones are avoided because of possible adverse effects on fetal cartilage development. Nitrofurantoin, ampicillin, and the cephalosporins have been used most extensively in pregnancy and are the regimens of choice for the treatment of asymptomatic or minimally symptomatic UTI ( Table 3 ). For pregnant women with overt pyelonephritis, admission to the hospital for parenteral therapy should be the standard of care; ß-lactams with or without aminoglycosides are the cornerstone of therapy.[11,51]




  #5

hi silatk

sulfonamide substitute in the site of bilirubin on the albumin , competitively and then increase the level of bili in the blood , because of this it hase been not used near around delivery,



  #6

hi silatk

sulfonamide substitute in the site of bilirubin on the albumin , competitively and then increase the level of bili in the blood , because of this it hase been not used near around delivery,



  #7

If you have other better and safer choices, dont choose TRIMETHOPIM.


  #8

yeah...we use either third generation ceph or nitrofurantoin...





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