From the FDA Drug Label
Piperacillin and tazobactam cross the placenta in humans. However, there are insufficient data with piperacillin and/or tazobactam in pregnant women to inform a drug-associated risk for major birth defects and miscarriage No fetal structural abnormalities were observed in rats or mice when piperacillin and tazobactam was administered intravenously during organogenesis at doses 1 to 2 times and 2 to 3 times the human dose of piperacillin and tazobactam, respectively, based on body-surface area (mg/m2)
The recommended antibiotic regimen for a urinary tract infection (UTI) with Pseudomonas in pregnancy is piperacillin-tazobactam.
- The piperacillin-tazobactam should be administered intravenously (IV), as the provided drug label only discusses IV administration.
- Key considerations:
- There are insufficient data on the use of piperacillin-tazobactam in pregnant women.
- No fetal structural abnormalities were observed in animal studies.
- The dosage should be adjusted in the presence of renal impairment 1
From the Research
For a urinary tract infection with Pseudomonas during pregnancy, intravenous (IV) therapy is typically recommended initially, followed by oral therapy based on susceptibility testing, with the preferred initial regimen being IV ceftazidime or IV piperacillin-tazobactam for 2-3 days, then transitioning to oral therapy if susceptibility allows, as recommended by the most recent study 2. The choice of antibiotic is crucial due to the resistance patterns of Pseudomonas, and treatment should be guided by culture results and antibiotic susceptibility testing, as highlighted in the study 3. Some key points to consider in the management of UTI with Pseudomonas in pregnancy include:
- The use of IV therapy initially, especially in severe cases or pyelonephritis, as noted in the study 4
- The importance of susceptibility testing to guide the choice of oral therapy, as emphasized in the study 5
- The need for close monitoring with repeat urine cultures after treatment to confirm clearance of infection, as recommended in the study 6
- The consideration of local resistance patterns and individual patient factors in adjusting the treatment regimen, as discussed in the study 2 It is essential to prioritize the most recent and highest quality study, which in this case is the 2022 study 2, to ensure the best possible outcome for the patient in terms of morbidity, mortality, and quality of life.