Metronidazole is used for antibiotic associated diarrhoea in pregnancy in UK

doi:10.1136/bmj.325.7369.903

BMJ 2002;325:903 ( 19 October )

Letters

Metronidazole is used for antibiotic associated diarrhoea in pregnancy in UK

The first 150 words of the full text of this article appear below.

EDITOR $---$ Barbut and Meynard quote US guidance when recommending vancomycin as first line treatment for antibiotic associateddiarrhoea in pregnancy.¹

In the United Kingdom guidance issued by the medicines information centres and the National Teratology Information Servicerecommends metronidazole rather than oral vancomycin after a carefulrisk assessment of eachdrug.

Vancomycin is poorly absorbed from normal, intact gastrointestinal mucosa, but an inflammatory bowel process can result inincreased absorption of the oral product. In patients with pseudomembranouscolitis vancomycin may occasionally reach therapeutic concentrationsin serum, which can theoretically damage a fetus's VIIIth cranialnerve.

In contrast, several epidemiological studies in women have shown no conclusive evidence that metronidazole causes an increasedrisk of malformations, stillbirths, or low birth weight.^2-4 Theaccumulated data on more than 1500 births with prenatal exposureto metronidazole suggests no increase in congenital anomalies.^2-4

In addition, a retrospective cohort study of nearly 1400 exposed pregnancies . . . [Full text of this article]