USE OF METRONIDAZOLE IN PREGNANCY

Metronidazole is an antimicrobial agent that is used for prophylaxis and treatment of anaerobic, protozoal, Helicobacter pylori and skin infections. It is commonly prescribed orally or as a gel for treatment of bacterial vaginosis and trichomonal infections. Where oral treatment is deemed appropriate, the manufacturer advises against a single high-dose regimen during pregnancy.

Metronidazole was teratogenic in some early animal studies, but this has proved difficult to reproduce. The available human data, which are almost exclusively based on oral exposure, do not, overall, indicate an increased risk of congenital malformation. There is also no indication of increased risks of preterm delivery, low infant birth weight, intrauterine death, or neonatal complications following metronidazole exposure in pregnancy. Metronidazole exposure in early pregnancy has been associated with miscarriage; however, it is possible that underlying maternal infection may play an independent role in increasing miscarriage risk.

Where possible, the results of culture and sensitivity tests should be available before making a treatment choice in accordance with local prescribing guidelines.

Exposure to metronidazole at any stage in pregnancy would not usually be regarded as medical grounds for termination of pregnancy or any additional fetal monitoring. However, other risk factors may be present in individual cases which may independently increase the risk of adverse pregnancy outcome. Clinicians are reminded of the importance of consideration of such factors when performing case-specific risk assessments.