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However, not all of them are safe to use during pregnancy. One of the components of bismuth subsalicylate is salicylate, which is a component that crosses the placenta. Due to this, there is an increased risk for intrauterine growth retardation, fetal hemorrhage, and maternal hemorrhage within organogenesis and in the second/third trimester. [12]
The synergy between trimethoprim and sulfamethoxazole was first described in the late 1960s. [25] [26] [27] Trimethoprim and sulfamethoxazole have a greater effect when given together than when given separately, because they inhibit successive steps in the folate synthesis pathway. They are given in a one-to-five ratio in their tablet ...
The discovery of antimicrobial agents contributed significantly to UTI management during the 20th century. Nitrofurantoin emerged as the first practical and safe urinary antimicrobial agent, but it was with limited spectrum of activity. [48] Subsequently, in the 1970s, beta-lactam antibiotics and TMP/SMX became available for UTI therapy. [48]
Evidence of safety in early pregnancy is mixed as of 2017. [40] The American College of Obstetricians and Gynecologists states that while they can be used in the first trimester other options may be preferred. [40] They remain a first line treatment in the second trimester. [40]
Safety concerns exist for fluoroquinolone use during pregnancy, so they are contraindicated unless no other safe alternative antibiotic exists. [54] However, one meta-analysis looking at the outcome of pregnancies involving quinolone use in the first trimester found no increased risk of malformations. [55]
Exposure to quinolones, including levofloxacin, during the first-trimester is not associated with an increased risk of stillbirths, premature births, birth defects, or low birth weight. [ 24 ] Levofloxacin does penetrate into breastmilk, though the concentration of levofloxacin in the breastfeeding infant is expected to be low. [ 25 ]
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The allocation of a B category does not imply greater safety than C category Medicines in category D are not absolutely contraindicated during pregnancy (e.g. anticonvulsants) The system, as outlined below, was developed by medical and scientific experts based on available evidence of risks associated with taking particular medicines while ...
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