What is the recommended treatment for acute nasopharyngitis in pregnancy?

Treatment of Acute Nasopharyngitis in Pregnancy

For acute nasopharyngitis during pregnancy, saline nasal rinses and topical corticosteroid nasal sprays are the safest and most effective first-line treatments. 1, 2

First-Line Safe Treatments

• Saline nasal rinses are the safest and most effective first-line treatment for symptom relief during pregnancy 2, 1
• Intranasal corticosteroids (budesonide, fluticasone, mometasone) at recommended doses are considered safe for controlling nasal symptoms 2, 1
• These medications should be used at the lowest effective dose for the shortest duration necessary 1

Medications to Avoid

• Oral decongestants should not be used, especially during the first trimester, due to potential association with congenital malformations including gastroschisis 2, 1
• First-generation antihistamines with sedative properties should be avoided due to anticholinergic effects 2, 1
• Phenylephrine should be avoided during pregnancy, particularly in the first trimester 1

If Bacterial Infection is Suspected

• Antibiotics should only be used when there is endoscopic evidence of purulence suggesting bacterial infection 2
• Penicillins and cephalosporins are the safest antibiotic classes during pregnancy 2, 3
• Avoid tetracyclines, aminoglycosides, trimethoprim-sulfamethoxazole, and fluoroquinolones due to potential fetal risks 2, 4
• For penicillin-allergic patients, azithromycin is recommended as a safe alternative 3

Supportive Measures

• Adequate hydration and rest are important supportive measures 3
• Warm facial packs may provide comfort 3
• Acetaminophen (paracetamol) can be used for fever and pain control if needed 4
• Mechanical nasal alar dilators are safe and may provide some relief 5, 6

Important Considerations

• The first trimester carries the highest risk for medication-induced teratogenicity, so non-pharmacological approaches should be prioritized during this period 1, 4
• Consultation with the patient's obstetrician is recommended when considering any medication during pregnancy 2
• Untreated severe respiratory symptoms can negatively impact maternal quality of life and potentially affect fetal well-being, highlighting the importance of appropriate management 7

Treatment Algorithm

1. Start with saline nasal rinses and mechanical measures (nasal alar dilators) 2, 6
2. If symptoms persist, add a topical nasal corticosteroid (preferably budesonide, fluticasone, or mometasone) 2, 1
3. For fever or pain, use acetaminophen 4
4. If purulent discharge is present, consider appropriate antibiotics after consultation with obstetrician 2, 3
5. Monitor for signs of worsening symptoms that might indicate complications requiring immediate attention 3