Thursday, January 14, 2021

gallstone related acute cholecystitis in pregnancy

 Q: 24 years old female in 22 weeks of pregnancy is admitted to ICU with concern for sepsis secondary to gallstone related acute cholecystitis. Which of the following antibiotics should be avoided? (select one)

A) Metronidazole 

B) Aztreonam 

C) Ceftriaxone 

D) Clindamycin 

E) Meropenem 

Answer:  (Meropenem)

Management of gallstone-related complications is usually supportive in pregnancy and not much different than the general population including surgery if required. Like all other antibiotics, two classes of antibiotics should be avoided in pregnancy i.e., fluoroquinolones and carbapenems due to the risk of fetal toxicity. 

Monotherapy is usually enough with ampicillin-sulbactam, piperacillin-tazobactam, or ticarcillin-clavulanate. Another acceptable regimen is a combination of third-generation cephalosporin (ceftriaxone) and metronidazole. Clindamycin can be used in penicillin allergy. Aztreonam is also described as safe in pregnancy.





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3. İlhan M, İlhan G, Gök AFK, Günay K, Ertekin C. The course and outcomes of complicated gallstone disease in pregnancy: Experience of a tertiary center. Turk J Obstet Gynecol. 2016;13(4):178-182. doi:10.4274/tjod.65475

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