Acute pyelonephritis in pregnancy: a prospective study of oral versus intravenous antibiotic therapy
Article Abstract:
An infection of the kidney, pyelonephritis, is the number one cause of hospital admission of during pregnancy that is not related to the pregnancy itself. Intravenous (IV) antibiotics are usually given until symptoms such as fever, tenderness in the kidney area, positive urine culture and elevated white blood cell count resolve. This treatment is generally followed by oral antibiotics for two weeks. Pyelonephritis in nonpregnant patients is treated effectively with oral antibiotics alone, without the added expense of a hospital admission. The effectiveness of oral antibiotic therapy in the pregnant patient with pyelonephritis is evaluated. There were 90 patients initially enrolled in the study; 35 women received oral cephalothin (500 milligrams every six hours) and 42 women received IV cephalothin (one gram every six hours). Bacteria were cultured from the blood in 13 patients, who were then assigned to receive the IV antibiotic regimen. The treatment successfully eradicated the bacterial infection in 91.4 percent of the patients receiving oral antibiotics and 92.9 percent of the patients receiving IV antibiotics. There was no one factor that distinguished the patients who had successful treatment from the patients with failed treatment. There were three treatment failures in each treatment group. Significant complications were experienced by two patients (2.2 percent); one patient developed swelling the lungs (pulmonary edema) and problems in the blood clotting system. The other patient developed hemolytic anemia, a condition that causes red blood cell destruction. Both of these patients had blood cultures positive for E. coli. An alternative E. coli-sensitive antibiotic resulted in successful treatment. Oral antibiotic therapy was a safe and effective treatment, comparable to IV antibiotics, for pyelonephritis in the pregnant patient without positive blood culture indicating bacteremia. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Obstetrics and Gynecology
Subject: Health
ISSN: 0029-7844
Year: 1990
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Sequential outpatient application of intravaginal prostaglandin E2 gel in the management of postdates pregnancies
Article Abstract:
Pregnancies that continue beyond the expected due date are associated with an increased risk for illness and death in newborns. Labor can be induced with medication, but it often lasts much longer than spontaneous labor and is twice as likely to require cesarean section. Induction of labor is more successful when the cervix is ripe for delivery (that is, has begun to soften). Several recent inpatient studies have found that applying prostaglandin E2 (PGE2) gel intravaginally (within the vagina) can cause the cervical ripening that is needed for effective induction. The gel was assessed in women with uncomplicated pregnancies who were beyond term to see if outpatient use of PGE2 is safe and effective in ripening the cervix prior to inducing labor. Fifty women with gestational dates (length of pregnancy) of 287 days and poor cervical ripeness participated in the study. The gel with PGE2 was given to 24 women; the remaining 26 received a placebo (inactive) gel. The results showed no improvement in cervical ripening when either gel was applied. Other factors such as length of pregnancy, use of medication to induce labor, need for cesarean section, and infant health did not differ between the two groups. No side effects from gel usage were reported. These results indicate that PGE2 given at the dosage levels used in this study was not effective in hastening cervical ripening. Previous inpatient studies, which used higher dosage levels, have shown it can induce uterine contractions and cervical ripening. Further studies are needed to find a safe and effective dose that can be used on an outpatient basis. More frequent application of the PGE2 gel and earlier use may be considered. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Obstetrics and Gynecology
Subject: Health
ISSN: 0029-7844
Year: 1991
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- Abstracts: Physical fitness and all-cause mortality: a prospective study of healthy men and women. Changes in physical fitness and all-cause mortality: a prospective study of healthy and unhealthy men
- Abstracts: A randomized, double-blind, placebo-controlled trial of oral antibiotic therapy following intravenous antibiotic therapy for postpartum endometritis