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Antibiotics in Pregnancy

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121. Antibiotic prophylaxis for operative vaginal delivery. Full Text available with Trip Pro

infectious puerperal morbidities in women undergoing operative vaginal deliveries including vacuum or forceps deliveries, or both.We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 August 2014).All randomised trials comparing any prophylactic antibiotic regimens with placebo or no treatment in women undergoing vacuum or forceps deliveries were eligible. Participants were all pregnant women without evidence of infections or other indications for antibiotics of any gestational (...) Antibiotic prophylaxis for operative vaginal delivery. Vacuum and forceps assisted vaginal deliveries are reported to increase the incidence of postpartum infections and maternal readmission to hospital compared to spontaneous vaginal delivery. Prophylactic antibiotics may be prescribed to prevent these infections. However, the benefit of antibiotic prophylaxis for operative vaginal deliveries is still unclear.To assess the effectiveness and safety of antibiotic prophylaxis in reducing

2014 Cochrane

122. Prophylactic antibiotics for manual removal of retained placenta in vaginal birth. (Abstract)

not and to identify the appropriate regimen of antibiotic prophylaxis for this procedure.We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 July 2014).All randomized controlled trials comparing antibiotic prophylaxis and placebo or non antibiotic use to prevent endometritis after manual removal of placenta in vaginal birth.There are no included trials. In future updates, if we identify eligible trials, two review authors will independently assess trial quality and extract dataNo studies (...) Prophylactic antibiotics for manual removal of retained placenta in vaginal birth. Retained placenta is a potentially life-threatening condition because of its association with postpartum hemorrhage. Manual removal of placenta increases the likelihood of bacterial contamination in the uterine cavity.To compare the effectiveness and side-effects of routine antibiotic use for manual removal of placenta in vaginal birth in women who received antibiotic prophylaxis and those who did

2014 Cochrane

123. Routine blood cultures in the management of pyelonephritis in pregnancy for improving outcomes. Full Text available with Trip Pro

Routine blood cultures in the management of pyelonephritis in pregnancy for improving outcomes. Pyelonephritis is a type of urinary tract infection (UTI) that affects the upper urinary tract and kidneys, and is one of the most common conditions for hospitalisation among pregnant women, aside from delivery. Samples of urine and blood are obtained and used for cultures as part of the diagnosis and management of the condition. Acute pyelonephritis requires hospitalisation with intravenous (...) administration of antimicrobial agents. Several studies have questioned the necessity of obtaining blood cultures in addition to urine cultures, citing cost and questioning whether blood testing is superfluous. Pregnant women with bacteraemia require a change in the initial empirical treatment based on the blood culture. However, these cases are not common, and represent approximately 15% to 20% of cases. It is unclear whether blood cultures are essential for the effective management of the condition.To

2015 Cochrane

124. Interventions for preventing recurrent urinary tract infection during pregnancy. Full Text available with Trip Pro

Interventions for preventing recurrent urinary tract infection during pregnancy. Recurrent urinary tract infections (RUTI) are common in women who are pregnant and may cause serious adverse pregnancy outcomes for both mother and child including preterm birth and small-for-gestational-age babies. Interventions used to prevent RUTI in women who are pregnant can be pharmacological (antibiotics) or non-pharmacological (cranberry products, acupuncture, probiotics and behavioural modifications). So (...) far little is known about the best way to prevent RUTI in pregnant women.To assess the effects of interventions for preventing RUTI in pregnant women.The primary maternal outcomes were RUTI before birth (variously defined) and preterm birth (before 37 weeks). The primary infant outcomes were small-for-gestational age and total mortality.We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (20 May 2015) and reference lists of retrieved articles.Published, unpublished

2015 Cochrane

125. Bacterial Vaginosis in Pregnant Persons to Prevent Preterm Delivery: Screening

vaginal clindamycin) presented results for preterm delivery at less than 34 weeks, and the results were mixed. Potential Harms The harms of screening for bacterial vaginosis in pregnant persons and treatment with antibiotics generally involve adverse effects such as gastrointestinal upset and vaginal candidiasis. Four observational studies and 2 large meta-analyses of observational studies on the use of metronidazole during pregnancy for any reason (not limited to bacterial vaginosis) reported (...) of the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services. Collapse All Bacterial vaginosis is common and is caused by a disruption of the microbiological environment in the lower genital tract. In the US, reported prevalence of bacterial vaginosis among pregnant women ranges from 5.8% to 19.3% and is higher in some races/ethnicities. Bacterial vaginosis during pregnancy has been associated with adverse obstetrical outcomes including preterm delivery, early

2020 U.S. Preventive Services Task Force

126. Stopping the effective non-fluoroquinolone antibiotics at day 7 vs continuing until day 14 in adults with acute pyelonephritis requiring hospitalization: A randomized non-inferiority trial. Full Text available with Trip Pro

(non-FQ) antibiotics.Hospitalized adult men and non-pregnant women with culture-confirmed APN were eligible for participation after they had clinically improved following empirical or culture-guided treatment with intravenous non-FQ antibiotic(s). We excluded patients with severe sepsis, abscesses, prostatitis, recurrent or catheter-associated urinary tract infection, or urinary tract obstruction. We randomized eligible patients on Day 7 of effective treatment and assessed them at Weeks 1 and 6 (...) Stopping the effective non-fluoroquinolone antibiotics at day 7 vs continuing until day 14 in adults with acute pyelonephritis requiring hospitalization: A randomized non-inferiority trial. To evaluate whether stopping the effective antibiotic treatment following clinical improvement at Day 7 (Truncated treatment) would be non-inferior to continued treatment until Day 14 (Continued treatment) in patients with acute pyelonephritis (APN) requiring hospitalization treated with non-fluoroquinolone

2018 PLoS ONE

127. Antibiotics for amniotic-fluid colonization by Ureaplasma and/or Mycoplasma spp. to prevent preterm birth: A randomized trial. Full Text available with Trip Pro

Antibiotics for amniotic-fluid colonization by Ureaplasma and/or Mycoplasma spp. to prevent preterm birth: A randomized trial. To assess whether antibiotics used for treatment in asymptomatic second-trimester women positive for Mycoplasma or Ureaplasma spp. detected by amniotic-fluid PCR prevents preterm delivery.A randomized, double-blind, placebo-controlled trial.10 maternal fetal medicine centers in France.Women with a singleton pregnancy who underwent amniocentesis between 16 and 20 weeks (...) total, 1043 women underwent amniotic-fluid screening with specific PCR detection between July 2008 and July 2011: PCR detection failed in 27 (2.6%), and 20 (1.9%) underwent termination of pregnancy. Among the 1016 women with PCR results, 980 had available data for the primary outcome (delivery before 37 weeks) and 29 (3.0%) were positive for Ureaplasma and/or Mycoplasma spp. Because of the low rate of women with PCR-positive findings, the trial was stopped prematurely. In total, 19 women were

2018 PLoS ONE Controlled trial quality: predicted high

128. Safety Profile of Drug Use During Pregnancy at Peripheral Health Centres in Burkina Faso: A Prospective Observational Cohort Study Full Text available with Trip Pro

of malaria during pregnancy and delivery in Burkina Faso's health facilities. It also aimed to assess factors associated with the use of potentially risky drugs over the entire course of pregnancy.We enrolled pregnant women from their first antenatal care visit and followed them up until delivery, and collected data on drug use. Based on United States Food and Drug Administration (FDA) or Australian Therapeutic Goods Administration (TGA) drug risk classification, drugs were classified into three groups (...) : 'probably safe', 'potentially risky' or 'unclassified'. A modified classification was built to take into account national malaria policy treatment guidelines and World Health Organization Malaria Treatment Guidelines recommending malaria chemoprophylaxis during pregnancy.Out of 2371 pregnant women enrolled, 56.7% used at least one medication during the entire course of the pregnancy (excluding sulphadoxine-pyrimethamine and iron-folic acid). A total of 101 different types of medications were used

2018 Drugs - real world outcomes

129. The Management of Nausea and Vomiting of Pregnancy and Hyperemesis Gravidarum

settings. It gives advice for multidisciplinary professionals involved in the care of women with these conditions, including how to counsel and support women before, during and after their pregnancies. 2. Introduction and background epidemiology NVP affects up to 80% of pregnant women 1 and is one of the most common indications for hospital admission among pregnant women, with typical stays of between 3 and 4 days. 2–4 For this guideline, NVP is defined as the symptom of nausea and/or vomiting during (...) early pregnancy where there are no other causes. HG is the severe form of NVP , which affects about 0.3–3.6% of pregnant women. 1,5–7 Reported HG recurrence rates vary, from 15.2% in a Norwegian hospital registry study 8 to 81% if using self-reported diagnosis. 9 © Royal College of Obstetricians and Gynaecologists 5 of 27 RCOG Green-top Guideline No. 69 P C D C C C D D DThe aetiological theories for NVP and HG range from the fetoprotective and genetic to the biochemical, immunological and biosocial

2016 Royal College of Obstetricians and Gynaecologists

130. Polycystic ovary syndrome: metformin in women not planning pregnancy

Polycystic ovary syndrome: metformin in women not planning pregnancy P Poly olycystic o cystic ovary syndrome: metformin in women vary syndrome: metformin in women not planning pregnancy not planning pregnancy Evidence summary Published: 21 February 2013 nice.org.uk/guidance/esuom6 pathways K Ke ey points from the e y points from the evidence vidence The content of this evidence summary was up-to-date in February 2013. See summaries of product characteristics (SPCs), British national formulary (...) (BNF) or the MHRA or NICE websites for up-to-date information. Metformin is licensed in the UK for the control of blood glucose in people with type 2 diabetes. It has also been used to treat polycystic ovary syndrome (PCOS). Metformin is not licensed in the UK for this indication so its use in PCOS is off-label. This evidence summary relates to metformin for PCOS in women who are not planning pregnancy. The use of metformin for treating infertility in women with PCOS is not covered by this evidence

2013 National Institute for Health and Clinical Excellence - Advice

131. Hypertension in pregnancy

- Options for local implementation No QIPP indicators were found during the review of this topic. NICE quality standards NICE quality standards Women of childbearing potential with treated hypertension are given information annually about safe antihypertensive treatment during pregnancy. Pregnant women at increased risk of pre-eclampsia at the booking appointment are offered a prescription of 75–150 mg of aspirin to take daily from 12 weeks until birth. Pregnant women taking antihypertensive medication (...) have a blood pressure target of 135/85 mmHg or less. Pregnant women with severe hypertension are admitted for a full assessment, carried out by a healthcare professional trained in managing hypertension in pregnancy. Women with pre-eclampsia who have severe hypertension or are at a high risk of adverse events, or if there are any clinical concerns are admitted to hospital and monitored. Women with pre-eclampsia have a senior obstetrician involved in any decisions about the timing of birth. Women

2019 NICE Clinical Knowledge Summaries

132. Reducing the Risk - Thrombosis and Embolism during Pregnancy and the Puerperium

with previous VTE be managed in pregnancy? (see Appendix IV) Single previous VTE Women with previous VTE should be offered prepregnancy counselling and a prospective management plan for thromboprophylaxis in pregnancy made. Those who become pregnant before receiving such counselling should be referred at the earliest opportunity in pregnancy to a clinician with expertise in thrombosis in pregnancy. C C C D D D D P PRCOG Green-top Guideline No. 37a © Royal College of Obstetricians and Gynaecologists 3 of 40 (...) be avoided antenatally and intrapartum because of the risk of anaphylactoid reaction. Oral thrombin and Xa inhibitors Non-vitamin K antagonist oral anticoagulants (NOACs) should be avoided in pregnant women. [New 2015] Use of NOACs is not currently recommended in women who are breastfeeding. [New 2015] Anti-embolism stockings The use of properly applied anti-embolism stockings (AES) of appropriate size and providing graduated compression with a calf pressure of 14–15 mmHg is recommended in pregnancy

2015 Royal College of Obstetricians and Gynaecologists

133. In utero exposure to antibiotics and risk of congenital malformations: A population-based study. (Abstract)

status and annual personal income.We found no increased risk of congenital malformations be related to first trimester in utero exposure to the 10 most commonly prescribed antibiotics in Denmark compared to a cohort of pregnant women exposed to penicillins that are considered safe during pregnancy. Compared to unexposed pregnancies, small increased risks for major malformations and cardiac malformations were apparent for pivmecillinam (OR 1.13; CI 1.06-1.19 and 1.15; CI 1.04-1.28, respectively (...) In utero exposure to antibiotics and risk of congenital malformations: A population-based study. Antibiotics are commonly prescribed during pregnancy. While the safety of most penicillins are well established, some controversy and uncertainty are associated with the use of other commonly prescribed antibiotics.To determine the risk of congenital malformations following first trimester in utero exposure to 10 commonly prescribed antibiotics in Denmark.This was a cohort study comprising all

2019 American Journal of Obstetrics and Gynecology

134. Procalcitonin and lung ultrasonography point-of-care testing to decide on antibiotic prescription in patients with lower respiratory tract infection in primary care: protocol of a pragmatic cluster randomized trial. Full Text available with Trip Pro

, pregnancy, inability to provide informed consent and unavailability of the GP. Patients will fill in a 28 day-symptom diary and will be contacted by phone on days 7 and 28. The primary outcome is the proportion of patients prescribed any antibiotic up to day 28. Secondary outcomes include clinical failure by day 7 (death, admission to hospital, absence of amelioration or worsening of relevant symptoms) and by day 28, duration of restricted daily activities, episode duration as defined by symptom score (...) Procalcitonin and lung ultrasonography point-of-care testing to decide on antibiotic prescription in patients with lower respiratory tract infection in primary care: protocol of a pragmatic cluster randomized trial. A minority of patients presenting with lower respiratory tract infection (LRTI) to their general practitioner (GP) have community-acquired pneumonia (CAP) and require antibiotic therapy. Identifying them is challenging, because of overlapping symptomatology and low diagnostic

2019 BMC pulmonary medicine Controlled trial quality: predicted high

135. Association of the Eukaryotic Vaginal Virome with Prophylactic Antibiotic Exposure and Reproductive Outcomes in a Subfertile Population Undergoing In Vitro Fertilization: A Prospective Exploratory Study. Full Text available with Trip Pro

, viral diversity was higher in the group that did not achieve clinical pregnancy compared to those who did (p=0.06).We demonstrate the vaginal eukaryotic virome in women undergoing IVF is associated with antibiotic exposure. Additionally, we demonstrate an inverse trend between viral diversity and pregnancy, with a higher number of viruses detected associated with failure to achieve clinical pregnancy in the azithromycin group.© 2019 Royal College of Obstetricians and Gynaecologists. (...) Association of the Eukaryotic Vaginal Virome with Prophylactic Antibiotic Exposure and Reproductive Outcomes in a Subfertile Population Undergoing In Vitro Fertilization: A Prospective Exploratory Study. The objective of this study was to use high-throughput sequencing to describe the vaginal eukaryotic DNA virome in patients undergoing in vitro fertilization (IVF) to examine associations between the vaginal virome, antibiotic exposure, and IVF outcomes.Prospective exploratory study SETTING

2019 BJOG

136. The influence of timing of Maternal administration of Antibiotics during cesarean section on the intestinal Microbial colonization in Infants (MAMI-trial): study protocol for a randomised controlled trial. Full Text available with Trip Pro

during pregnancy and delivery. Recent revisions to international obstetric guidelines have resulted in the exposure of all infants born by caesarean section (CS) to broad-spectrum antibiotics perinatally. To date, the consequences of these new guidelines on neonatal gut colonisation and the associated short- and long-term health implications have not yet been addressed. The aim of this study is to investigate the influence of the timing of antibiotic administration during CS to the mother (...) The influence of timing of Maternal administration of Antibiotics during cesarean section on the intestinal Microbial colonization in Infants (MAMI-trial): study protocol for a randomised controlled trial. A disturbance in the early colonisation of the gut by microorganisms is associated with an aberrant innate immune system and a variety of clinical conditions later in life. Several factors are considered to influence this initial colonisation, including maternally administered antibiotics

2019 Trials Controlled trial quality: uncertain

137. An Integrated Safety Summary of Omadacycline, a Novel Aminomethylcycline Antibiotic. Full Text available with Trip Pro

An Integrated Safety Summary of Omadacycline, a Novel Aminomethylcycline Antibiotic. Omadacycline is a semisynthetic tetracycline antibiotic. Phase III clinical trial results have shown that omadacycline has an acceptable safety profile in the treatment of acute bacterial skin and skin structure infections and community-acquired bacterial pneumonia. Similar to most tetracyclines, transient nausea and vomiting and low-magnitude increases in liver aminotransferases were the most frequent (...) treatment-emergent adverse events in phase III studies but were not treatment limiting. Package insert warnings and precautions for omadacycline include tooth discoloration; enamel hypoplasia; inhibition of bone growth following use in late pregnancy, infancy, or childhood up to 8 years of age; an imbalance in mortality (2%, compared with 1% in moxifloxacin-treated patients) was observed in the phase III study in patients with community-acquired bacterial pneumonia. Omadacycline has no effect on the QT

2019 Clinical Infectious Diseases

138. The association between antibiotics in the first year of life and child growth trajectory. Full Text available with Trip Pro

) and 6 year follow-up study (6YFU) were included. Antibiotic exposures, weight and height measurements were collected from birth through the first 12 months, and then again at 6 years. Linear mixed effects growth modeling, controlling for exclusive breastfeeding, socio-demographic factors, smoking during pregnancy, gestational diabetes, and maternal pre-pregnancy weight status, was used to examine the association between antibiotic exposure and child growth trajectories through age 6 years.The (...) The association between antibiotics in the first year of life and child growth trajectory. Antibiotics are frequently prescribed to children, and may be an environmental influence that contributes to the increasing prevalence of childhood obesity. The aim of this study was to examine the effect of antibiotic use in the first year of life on child growth trajectories from birth to age 6 years including significant covariates.Data from 586 children in the Infant Feeding Practices II (IFPS II

2019 BMC Pediatrics

139. The Effect of Non-penicillin Antibiotic Regimens on Neonatal Outcomes in Preterm Premature Rupture of Membranes. Full Text available with Trip Pro

The Effect of Non-penicillin Antibiotic Regimens on Neonatal Outcomes in Preterm Premature Rupture of Membranes. Objective  A 7-day course of a penicillin (PCN) and macrolide is standard of care (SAR) in preterm premature rupture of membranes (PPROM). Data regarding alternative antibiotic regimens are limited. We sought to assess the impact of non-PCN regimens on neonatal outcomes. Study Design  Secondary analysis of randomized controlled trial of antenatal magnesium sulfate. Singleton (...) , nonanomalous pregnancies complicated by PPROM at > 24 weeks of gestation receiving the SAR were compared with women receiving a non- β -lactam regimen and a macrolide (NPCR). Primary outcome was a neonatal composite. Secondary outcomes included pregnancy latency, endometritis, and chorioamnionitis. Results  A total of 949 women met inclusion criteria; 821(56%) received the SAR and 128(8.8%) received NPCR. Adjusted models did not demonstrate worse outcomes (AOR [adjusted odds ratio] = 0.50; 95% CI

2019 AJP Reports Controlled trial quality: predicted high

140. Impact of Azithromycin-Based Extended-Spectrum Antibiotic Prophylaxis on Noninfectious Cesarean Wound Complications. (Abstract)

. This is a secondary analysis of the C/SOAP (Cesarean Section Optimal Antibiotic Prophylaxis) randomized controlled trial, which enrolled women with singleton pregnancies ≥24 weeks who were undergoing nonelective cesarean. Women were randomized to adjunctive azithromycin or identical placebo up to 1 hour preincision. All wound complications occurring within 6 weeks were adjudicated into infection and noninfectious wound complications (seroma, hematoma, local cellulitis, and other noninfectious wound breakdown (...) Impact of Azithromycin-Based Extended-Spectrum Antibiotic Prophylaxis on Noninfectious Cesarean Wound Complications.  Adding azithromycin to standard antibiotic prophylaxis for unscheduled cesarean delivery has been shown to reduce postcesarean infections. Because wound infection with ureaplasmas may not be overtly purulent, we assessed the hypothesis that azithromycin-based extended-spectrum antibiotic prophylaxis also reduces wound complications that are identified as noninfectious

2019 American journal of perinatology Controlled trial quality: predicted high

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