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Metronidazole recommended for pregnant women for the treatment of antibiotic-associated diarrhea

Antibiotic-associated diarrhea (AAD) is a common side effect of antibiotic therapy and occurs in approximately 5 to 30% of patients.

In accordance with the recommendations of the Infectious Diseases Society of America (IDSA), metronidazole is the drug of choice for the treatment of AAD. However, during the development of ADA in pregnant women, it was recommended to administer vancomycin by mouth, because the use of metronidazole during pregnancy was associated with a potential risk of harmful effects of the drug ( malformations, stillbirth or low fetal weight).

Researchers in the UK currently recommend using metronidazole rather than vancomycin as the drug of choice for DAA in pregnant women.

Vancomycin is poorly absorbed through a healthy lining of the gastrointestinal tract, however, in the inflammatory process, the degree of absorption increases considerably. In pregnant women with pseudomembranous colitis, serum vancomycin levels can reach a therapeutic level, which can theoretically damage the VIII pair of cranial nerves of the fetus.

Researchers confirm the benefits of metronidazole in the treatment of ADA in pregnant women by the results of numerous clinical studies that have proven the safety of its use during pregnancy. An analysis of the medical history of more than 1,500 children exposed to metronidazole during the prenatal period showed no increase in the risk of birth defects. A retrospective study of almost 1,400 cases of pregnancy in which metronidazole treatment was used did not show an increase in the incidence of birth defects and low birth weight in children born. In addition, a study of cases of congenital malformations in Hungary in 1980-1991. did not show a link between the occurrence of fetal malformations and metronidazole treatment in 266 women during the last trimester of pregnancy.

To identify the possible long-term effects of exposure to metronidazole during the prenatal period, if any, a 20-year study is currently underway, which to date has not shown an increase in the frequency of neoplasms clever in these patients.

Thus, based on data on the efficacy and safety of metronidazole and taking into account insufficient information concerning the use of vancomycin during pregnancy, specialists from the United Kingdom recommend the use of metronidazole in pregnant women at a dose of 0.4 g 3 times a day, rather than vancomycin.