From the Guidelines
The treatment plan for a pregnant woman with a bacterial or viral infection should prioritize the use of pregnancy-category A or B medications, with careful consideration of the specific pathogen, infection site, severity, and pregnancy trimester. For bacterial infections, such as group B streptococcal disease, antibiotics like penicillin G (5 million units IV initial dose, then 2.5–3.0 million units every 4 hrs until delivery) or ampicillin (2 g IV initial dose, then 1 g IV every 4 hrs until delivery) may be prescribed, as recommended by the CDC guidelines 1. For viral infections, treatment is often supportive care including rest, hydration, and acetaminophen (up to 1000mg every 6 hours, not exceeding 4000mg daily) for fever and pain, with severe viral infections like influenza potentially warranting oseltamivir (75mg twice daily for 5 days). Regular prenatal care should continue with more frequent monitoring if needed, and treatment decisions should balance maternal benefit against fetal risk, with some infections potentially causing pregnancy complications or congenital abnormalities if left untreated, as noted in the clinical practice guidelines for the management of liver diseases in pregnancy 1. In cases of Lyme disease, human granulocytic anaplasmosis, and babesiosis, pregnant and lactating patients may be treated similarly to nonpregnant patients, except that doxycycline should be avoided, as recommended by the Infectious Diseases Society of America guidelines 1. Key considerations in developing a treatment plan include:
- The specific pathogen and infection site
- The severity of the infection
- The pregnancy trimester
- The potential risks and benefits of treatment for both mother and baby
- The need for consultation between obstetricians and infectious disease specialists to develop the safest, most effective treatment plan. In general, the goal of treatment should be to minimize morbidity, mortality, and impact on quality of life for both the mother and the baby, while carefully considering the potential risks and benefits of different treatment options, as emphasized in the guidelines for the management of liver diseases in pregnancy 1.
From the Research
Treatment Plan for Pregnant Women with Bacterial or Viral Infections
The treatment plan for a pregnant woman with a bacterial or viral infection should be approached with caution, considering the potential risks and benefits of medication use during pregnancy.
- Antiviral Medications: Acyclovir and trichloroacetic acid are considered safe to use in pregnancy 2. Docosanol, imiquimod, and penciclovir are likely safe but should be used as second-line agents.
- Antifungal Medications: Clotrimazole, miconazole, and nystatin are considered first-line agents 2. Butenafine, ciclopirox, naftifine, oxiconazole, and terbinafine may be used after the above agents.
- Corticosteroids: Corticosteroids can be beneficial in treating certain infections, such as bacterial meningitis, tuberculous meningitis, and severe typhoid fever 3. However, they should be used with caution and only when the benefits outweigh the risks.
- Dose and Directions: The dose and directions for each medication should be carefully considered and individualized based on the specific infection, gestational age, and patient characteristics.
Considerations for Medication Use in Pregnancy
When using medications during pregnancy, it is essential to consider the potential risks and benefits, including the risk of congenital birth defects, miscarriage, and other adverse outcomes 4, 5.
- Risk Perception: Pregnant women's perception of risks and benefits of medication use can vary depending on individual characteristics, such as trimester, parity, and family history of birth defects 5.
- Medication Safety: The safety profile of medications during pregnancy should be carefully evaluated, and medications with known teratogenic effects should be avoided whenever possible 2, 4.