BMJ 2002;325:903 ( 19 October )

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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 associated diarrhoea in pregnancy.1

In the United Kingdom guidance issued by the medicines information centres and the National Teratology Information Service recommends metronidazole rather than oral vancomycin after a careful risk assessment of each drug.

Vancomycin is poorly absorbed from normal, intact gastrointestinal mucosa, but an inflammatory bowel process can result in increased absorption of the oral product. In patients with pseudomembranous colitis vancomycin may occasionally reach therapeutic concentrations in serum, which can theoretically damage a fetus's VIIIth cranial nerve.

In contrast, several epidemiological studies in women have shown no conclusive evidence that metronidazole causes an increased risk of malformations, stillbirths, or low birth weight.2-4 The accumulated data on more than 1500 births with prenatal exposure to 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]
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