Less common bacterial, fungal and viral infections: review of management in the pregnant patient

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Abstract

This review is a comprehensive summary of treatment options for pregnant patients with less common bacterial, fungal, and viral infections. It offers guidance to clinicians based on the most recently published evidence-based research and expert recommendations. A search of MEDLINE (inception to March 2021) and the CDC website was performed. Liposomal amphotericin B is the preferred therapy for cryptococcosis, histoplasmosis, oesophageal candidiasis, and coccidioidomycosis, especially during the first trimester due to teratogenic concerns with azole antifungals. For oral candidiasis, clotrimazole troches or miconazole mucoadhesive buccal tablets are recommended. A β-lactam antimicrobial is preferred over doxycycline for various manifestations of Lyme disease and the drug of choice for Pneumocystis pneumonia is trimethoprim/sulfamethoxazole. Acyclovir is the preferred antiviral for varicella zoster virus. Fluoroquinolones, macrolides, and aminoglycosides should be avoided if possible and there are alternate agents available for an effective treatment regimen. There is a scarcity of clinical data in pregnant patients with less common bacterial, fungal and viral infections. This population lacks definitive recommendations in many clinical practice guidelines. The key to optimizing therapy is a comprehensive review of the available evidence and a careful balance of risks and benefits before final treatment decisions.

Keywords: antibiotics, antifungals, antivirals, bacterial infection, fungal infection, pregnancy, teratogenicity, viral infection.

Citation: Gould AP, Winders HR, Stover KR, Bookstaver PB, Griffin B, Bland CM, Eiland LS, Murray M. Less common bacterial, fungal and viral infections: review of management in the pregnant patient. Drugs Context. 2021;10:2021-4-3. https://doi.org/10.7573/dic.2021-4-3

Contributions: All authors contributed to the design and implementation of the manuscript and to the interpretation of the information presented. All authors contributed to the writing of the manuscript and approved the final version for submission. All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.

Disclosure and potential conflicts of interest: MM: speaker for Merck, advisory boards for Theratechnologies and Viiv; PBB: speaker’s bureau, Biomerieux; content developer and speaker for TRC Healthcare; content developer and speaker for FreeCE.com; HRW: speaker’s bureau, bioMérieux; CB: Merck: speaker’s bureau and consultant; bioMerieux: consultant; Tetraphase: speaker’s bureau. The remaining authors report no conflicts of interest. The International Committee of Medical Journal Editors (ICMJE) Potential Conflicts of Interests form for the authors is available for download at: https://www.drugsincontext.com/wp-content/uploads/2021/09/dic.2021-4-3-COI.pdf

Acknowledgements: None.

Funding declaration: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Copyright: Copyright © 2021 Gould AP, Winders HR, Stover KR, Bookstaver PB, Griffin B, Bland CM, Eiland LS, Murray M. Published by Drugs in Context under Creative Commons License Deed CC BY NC ND 4.0 which allows anyone to copy, distribute, and transmit the article provided it is properly attributed in the manner specified below. No commercial use without permission.

Correct attribution: Copyright © 2021 Gould AP, Winders HR, Stover KR, Bookstaver PB, Griffin B, Bland CM, Eiland LS, Murray M. https://doi.org/10.7573/dic.2021-4-3. Published by Drugs in Context under Creative Commons License Deed CC BY NC ND 4.0.

Article URL: https://www.drugsincontext.com/less-common-bacterial,-fungal-and-viral-infections:-review-of-management-in-the-pregnant-patient

Correspondence: Milena Murray, Midwestern University College of Pharmacy, Department of Pharmacy Practice, 555 31st St, Downers Grove, IL, 60515, USA. Email: mmurra@midwestern.edu

Provenance: Invited; externally peer reviewed.

Submitted: 23 April 2021; Accepted: 24 August 2021; Publication date: 22 September 2021.

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