E-DRUG: E-DRUG Treatment of Amoebic dysentry during pregnancy

[Tim Dodd <timdodd@brain.net.pk>]

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E-DRUG Treatment of Amoebic dysentry during pregnancy

It is always difficult to decide to treat, and with what, during
pregnancy.  However it is often forgotten that not treating can also
carry risk to the baby and the mother.  In the case of amoebic dysentry
that risk may be significant.

My choice of treatment would be metronidazole.  Although the drug
readily crosses the placenta and is present in the foetus in similar
concentrations to the mother, a meta-analysis of the use of the drug
during pregnency suggested minimal risk of foetal damage (Burtin P et
al, Safety of Metronidazole in pregnancy: a meta-analysis.  Am J Obstet
& Gynecol 1995; 172: 525-9).  It should be borne in mind, however, that
the manufacturers and the Centres for Disease Control, when discussing
the treatmant of trichomoniasis, don not recommend the drug in the first
trimester, but are happy with its use in the second and third trimester
( Centre for Disease Control.  Sexually transmitted Diseases treatment
guidelines MMWR 1993: 42 (RR-14) 70-1).  In these cases I would expect
the manufacturer to cover themselves and it should be remembered that
there are suitable alternatives for the management of trichomoniasis.

So the real answer is we dont know, but we have pharmacists to make
pharmaceutical judgement where the answer is not known - that is our
role - and so if it where my patient I would use metronidazole at
standard dose, or even slightly higher dose to take account of the
increased volume of distribution.

Tim Dodd
Director of Pharmacy
Shaukat Khanum Memorial Cancer Hopsital, Lahore, Pakistan.
timdodd@brain.net.pk




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