The CDC recently reported (MMWR, 2018) on the ongoing use of sulfonamides and nitrofurantoin in the first trimester due to concerns regarding the possible risk for birth defects. The authors in this paper state the following:
According to 2011 guidelines from the Infectious Diseases Society of America, nonpregnant women with uncomplicated UTIs should be treated with nitrofurantoin or trimethoprim-sulfamethoxazole. For pregnant women in their first trimester, a 2011 Committee Opinion from the American College of Obstetricians and Gynecologists recommended that sulfonamides and nitrofurantoin may be prescribed only if other antimicrobial therapies are deemed clinically inappropriate. In this analysis, 34.7% of pregnant women with UTIs in 2014 filled a prescription for nitrofurantoin and 7.6% filled a prescription for trimethoprim-sulfamethoxazole during their first trimester of pregnancy.
ACOG has replaced Committee opinion 294 (2011) with Committee Opinion 717 (2017) that still recommends the cautious use of sulfonamides and nitrofurantoin in the first trimester of pregnancy due to possible risk of birth defects, if no other alternatives are available.
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