Avoid Nitrofurantoin and Sulfa for UTI in pregnancy

The Buzz: A recent study suggests nitrofurantoin (Macrobid) and sulfonamides (eg Bactrim) are teratogenic and should be avoided in pregnant and possibly-pregnant women. 
Citation: Journal of Family Practice: April 2010 · Vol. 59, No. 04: 220-222

Summary: Asymptomatic UTIs are routinely treated in pregnant women because of the risks to mother and fetus. The study reviewed here used data from the National Birth Defects Prevention Study and compared interviews with mothers of babies with 30 kinds of birth defects (n = 13,155) with matched controls (n = 4941) and found significantly increased risks for multiple birth defects associated with both drugs. While the study design risks errors due to recall bias, women who expressed uncertainty were excluded and the size of the study suggests the findings may be real. The authors recommend avoiding both medications and using 1st- or second-generation cephalosporins (cephalexin 500 mg bid x 3 days, cefpodoxime 100 mg bid x 3 days) first-line until culture results are in.

Commentary: Remember that pregnant women require a urine culture for test of cure 1-2 weeks after treatment ends. 

By: Lisa Mihaly NP