{ "schema_version": 1, "kind": "condition", "id": "uti-in-pregnancy", "name": "Urinary Tract Infection in Pregnancy", "category": "infectious", "sources": "NICE Guideline NG109 UTI in Pregnancy 2018 · Egyptian National Drug Formulary - Antimicrobial 2023 (nitrofurantoin monograph, prophylaxis for recurrent cystitis) · Selexid 200 mg Film-coated Tablets (pivmecillinam hydrochloride) SmPC sections 4.1, 4.2, 4.3, 4.4 and 4.6 (eMC product 3799) · Urinary Tract Infection in Pregnancy - disease-level clinical article (uti-in-pregnancy-full.txt) · PARACETAMOL = ACETAMINOPHEN oral - MSF Medical Guidelines (Essential drugs), Dosage", "review_status": "reviewed", "verified_against": "Urinary Tract Infection in Pregnancy - disease-level clinical article (uti-in-pregnancy-clinical.txt) · Urinary Tract Infection in Pregnancy - disease-level clinical article (uti-in-pregnancy-full.txt) · Egyptian National Drug Formulary - Antimicrobial 2023 (Version 1.0), p. 246, ceftriaxone monograph, Prescribing Limits: \"Pediatric Patients Endocarditis or meningitis: Maximum 4 g daily. Most other infections: Maximum 2 g daily.\" · Egyptian National Drug Formulary - Antimicrobial 2023 (nitrofurantoin monograph, prophylaxis for recurrent cystitis) · Selexid 200 mg Film-coated Tablets (pivmecillinam hydrochloride) SmPC sections 4.1, 4.2, 4.3, 4.4 and 4.6 (eMC product 3799)", "verified_date": "2026-08", "treatments": [ { "id": 1899, "generic": "Nitrofurantoin", "line": 1, "is_adjunct": false, "form": "oral.solid", "strength_mg": 100.0, "adult_dose": "100 mg modified-release twice daily with meals", "adult_duration": "7 days", "dose_source": "Egyptian National Drug Formulary - Antimicrobial 2023", "rationale": "Urinary antiseptic antibiotic concentrated in the urine, a first-line option for urinary tract infection in pregnancy; avoided at term because of the risk of neonatal haemolysis.", "cautions": [ "CONTRAINDICATED at term (38-42 weeks) due to neonatal haemolysis risk.", "A urine culture is mandatory 7 days post-treatment to confirm clearance.", "CrCl <60 mL/minute: Use is contraindicated." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Not applicable to pregnancy entry", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "COLIFURAN 100 MG 20 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "KAHIRA", "price_egp": 2.4, "pack_count": 20, "unit_price": 0.12, "strength_mg": 100.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "UVAMINE RETARD 100 MG 20 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MUP > ACINO", "price_egp": 47.0, "pack_count": 20, "unit_price": 2.35, "strength_mg": 100.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "MEPAFURAN 100 MG 20 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MEPACO", "price_egp": 54.0, "pack_count": 20, "unit_price": 2.7, "strength_mg": 100.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "MACROFURAN 100 MG 30 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "KAHIRA", "price_egp": 82.0, "pack_count": 30, "unit_price": 2.73, "strength_mg": 100.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "uti-in-pregnancy" }, { "id": 1900, "generic": "Cefalexin", "line": 1, "is_adjunct": false, "form": "oral.solid", "strength_mg": 500.0, "adult_dose": "500 mg twice daily (every 12 hours)", "adult_duration": null, "dose_source": "Egyptian National Drug Formulary - Antimicrobial 2023", "rationale": "Cephalosporin, and the condition's own article lists it among the regimens used in pregnancy - cephalexin, 250 mg to 500 mg by mouth twice a day, over 5 to 7 days. An option including near term, when nitrofurantoin is unsuitable. MSF Essential Drugs 2024 records no contra-indication in pregnancy.", "cautions": [ "Neither source splits pregnancy by trimester. The Egyptian formulary rates cephalexin Pregnancy Category B; MSF Essential Drugs 2024 is explicit on both counts, recording no contra-indication in pregnancy and none during breast-feeding.", "Penicillin allergy: Use with caution in patients with a history of penicillin allergy, especially IgE-mediated reactions (eg, anaphylaxis, angioedema, urticaria).", "Dose adjustment is required in renal impairment." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Not applicable to pregnancy entry", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "CEFLODIX 500 MG 12 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ARAB CAPS > PHAROPHARMA", "price_egp": 9.0, "pack_count": 12, "unit_price": 0.75, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "CEPHALEXCID 500 MG 12 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "CID", "price_egp": 10.3, "pack_count": 12, "unit_price": 0.86, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "CEPHOXIN 500MG 12 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PHARCO B", "price_egp": 10.5, "pack_count": 12, "unit_price": 0.88, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "CEPHALEXIN 500MG 10 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ARAB DRUG COMPANY (ADCO)", "price_egp": 10.1, "pack_count": 10, "unit_price": 1.01, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "MEDICEFLEXIN 500 MG 20 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "T3A PHARMA > RIVA PHARMA S.A.E.", "price_egp": 25.25, "pack_count": 20, "unit_price": 1.26, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "CEPHALEXIN 500MG 12 CAPS B.P.2007", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SHIFA MEDICAL PRODUCTS > OCTOBER PHARMA", "price_egp": 27.0, "pack_count": 12, "unit_price": 2.25, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "KEFLEX 500 MG 12 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "HIKMA PHARMA", "price_egp": 58.0, "pack_count": 12, "unit_price": 4.83, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "CEPOREX 500MG 12 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "GLAXO SMITHKLINE", "price_egp": 69.0, "pack_count": 12, "unit_price": 5.75, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "AMTHROST 125MG/5ML SUSP. 60ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SIGMA > SABAA", "price_egp": 4.0, "pack_count": null, "unit_price": null, "strength_mg": 125.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null }, { "trade_name": "AMTHROST 250MG/5ML SUSP. 60ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SIGMA > SABAA", "price_egp": 4.5, "pack_count": null, "unit_price": null, "strength_mg": 250.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null } ], "condition_id": "uti-in-pregnancy" }, { "id": 1902, "generic": "Referral & safety-netting (no drug therapy)", "line": 1, "is_adjunct": false, "form": null, "strength_mg": null, "adult_dose": null, "adult_duration": null, "dose_source": "Urinary Tract Infection in Pregnancy - disease-level clinical article (uti-in-pregnancy-clinical.txt)", "rationale": "Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen.", "cautions": [ "RED FLAG - Nitrofurantoin (and fosfomycin) should NOT be used to treat pyelonephritis because they do not achieve adequate kidney tissue levels - distinguish cystitis from pyelonephritis before using either.", "RED FLAG - Nitrofurantoin use is generally avoided at 36-37 weeks of gestation due to a theoretical risk of neonatal hemolytic anemia.", "RED FLAG - In G6PD deficiency, avoid nitrofurantoin and avoid the sulfa drugs: either can set off haemolysis.", "RED FLAG - Any detection of GBS in urine during pregnancy, regardless of colony count, requires intrapartum IV antibiotic prophylaxis to reduce early-onset neonatal GBS sepsis - separate from treating the UTI itself." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": null, "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [], "condition_id": "uti-in-pregnancy" }, { "id": 1903, "generic": "Ceftriaxone", "line": 1, "is_adjunct": false, "form": "injection", "strength_mg": 1000.0, "adult_dose": "IV or IM: 1-2 g once or divided twice daily", "adult_duration": "7-14 days", "dose_source": "Egyptian National Drug Formulary - Antimicrobial 2023 (Version 1.0), p. 246, ceftriaxone monograph, Prescribing Limits: \"Pediatric Patients Endocarditis or meningitis: Maximum 4 g daily. Most other infections: Maximum 2 g daily.\"", "rationale": "Third-generation cephalosporin for pyelonephritis in pregnancy requiring hospitalization; covers the common uropathogens. The Egyptian formulary treats ceftriaxone as compatible with both pregnancy and breastfeeding, provided the doses stay within the usual recommended range. The article specifies 1 g IV every 24 hours, which falls within the formulary range.", "cautions": [ "Do not use in hyperbilirubinemic neonates; ceftriaxone is reported to displace bilirubin from albumin binding sites.", "Ceftriaxone may exhibit incompatibility with calcium, causing precipitation.", "Ceftriaxone is considered compatible with pregnancy and breastfeeding when used in usual recommended doses." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Not applicable to pregnancy entry - the patient is a pregnant adult. Any weight-based child dose for this drug belongs on the paediatric urinary tract infection entry.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "ZOXIDEL 1 GM PD. FOR I.M. INJ.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "RAMEDA > DELTA PHARMA", "price_egp": 22.0, "pack_count": null, "unit_price": null, "strength_mg": 1000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "CEFTRIAXONE SODIUM 1 GM I.M.VIAL (KAHIRA)", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "KAHIRA", "price_egp": 29.0, "pack_count": null, "unit_price": null, "strength_mg": 1000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ZOXIDEL 1 GM PD. FOR I.V. INJ.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "RAMEDA > DELTA PHARMA", "price_egp": 29.0, "pack_count": null, "unit_price": null, "strength_mg": 1000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "WINTRIAXONE 1 GM PD. FOR I.V INJ.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SANOFI", "price_egp": 48.0, "pack_count": null, "unit_price": null, "strength_mg": 1000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "VOTRIAXONE 1 GM I.M VIAL", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "CHEMIPHARM", "price_egp": 56.0, "pack_count": null, "unit_price": null, "strength_mg": 1000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "OFRAMAX 1 GM I.M. VIAL", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "RAMEDA > SUN PHARMA EGYPT LIMITED", "price_egp": 71.0, "pack_count": null, "unit_price": null, "strength_mg": 1000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "TRIAXONE 1 GM I.M. VIAL", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "TABUK PHARMACEUTICAL MANUFACTURING COMPANY > TABUK PHARMA", "price_egp": 106.0, "pack_count": null, "unit_price": null, "strength_mg": 1000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "TRIAXONE 1 GM I.V VIAL", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "TABUK PHARMACEUTICAL MANUFACTURING COMPANY > TABUK PHARMA", "price_egp": 106.0, "pack_count": null, "unit_price": null, "strength_mg": 1000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "uti-in-pregnancy" }, { "id": 1901, "generic": "Amoxicillin + Clavulanic acid", "line": 2, "is_adjunct": false, "form": "oral.solid", "strength_mg": 625.0, "adult_dose": "Oral: Immediate release: 500 mg twice daily", "adult_duration": "7 days", "dose_source": "Egyptian National Drug Formulary - Antimicrobial 2023", "rationale": "Beta-lactam/beta-lactamase inhibitor combination, reserved for urinary tract infection when first-line agents are contraindicated or the organism is resistant to them. The condition's article lists it under alternative regimens and warns against plain amoxicillin or ampicillin as an empiric first choice, on the grounds of high E coli resistance. MSF Essential Drugs 2024 records no contra-indication in pregnancy.", "cautions": [ "Contraindicated in history of penicillin allergy or co-amoxiclav cholestatic jaundice.", "Use when first-line agents are contraindicated or the organism is resistant - not as the first empiric choice. On pregnancy MSF Essential Drugs 2024 is explicit: it records no contra-indication.", "Always obtain urine culture before initiating therapy." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Not applicable to pregnancy entry", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "AUJED 625 MG 12 F.C. TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SIGMA TEC > JEDCO INT. CO. FOR PHARMACEUTICALS", "price_egp": 19.2, "pack_count": 12, "unit_price": 1.6, "strength_mg": 625.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "E-MOXCLAV 625MG 10 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EIPICO", "price_egp": 30.0, "pack_count": 10, "unit_price": 3.0, "strength_mg": 625.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "DEXICLAVE 625 MG 12 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "RAMEDA > NOVELL PHARMA", "price_egp": 37.5, "pack_count": 12, "unit_price": 3.12, "strength_mg": 625.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "MAGNABIOTIC 625MG 8 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SEDICO", "price_egp": 37.0, "pack_count": 8, "unit_price": 4.62, "strength_mg": 625.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "CLAVIMOX 625 MG 12 F.C.TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PHARCO", "price_egp": 107.0, "pack_count": 12, "unit_price": 8.92, "strength_mg": 625.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "CURAM 625MG 12 F.C.TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SANDOZ > NOVARTIS", "price_egp": 108.0, "pack_count": 12, "unit_price": 9.0, "strength_mg": 625.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "AUGMENTIN 625 MG 10 F.C.TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MUP > SMITHKLINE BEECHAM", "price_egp": 117.0, "pack_count": 10, "unit_price": 11.7, "strength_mg": 625.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "CLAVOCILLIN 625 MG 10 DISPERSIBLE TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "RAMEDA > ORGANOPHARMA", "price_egp": 31.5, "pack_count": null, "unit_price": null, "strength_mg": 625.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "LARYNCLAVE 125/31 PD. FOR ORAL SUSP. 70ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MISR > AL ROWAD PHARMACEUTICAL INDUSTRIAL CO.", "price_egp": 8.0, "pack_count": null, "unit_price": null, "strength_mg": null, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null }, { "trade_name": "MEGACLAVOX 156MG/5ML PD. FOR SUSP. 60 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "CID", "price_egp": 8.0, "pack_count": null, "unit_price": null, "strength_mg": 156.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null } ], "condition_id": "uti-in-pregnancy" }, { "id": 1904, "generic": "Fosfomycin", "line": 2, "is_adjunct": false, "form": "oral.solid", "strength_mg": 3000.0, "adult_dose": "Oral: 3 g as a single dose", "adult_duration": "Single dose", "dose_source": "Egyptian National Drug Formulary - Antimicrobial 2023", "rationale": "Single-dose oral alternative for acute cystitis in pregnancy when nitrofurantoin or cephalosporins are unsuitable; Pregnancy Category B and not used for pyelonephritis.", "cautions": [ "Hypersensitivity reactions including anaphylactic shock have been reported; discontinue at first sign.", "Not used for pyelonephritis due to inadequate tissue levels in the kidney.", "Fosfomycin is Pregnancy Category B; use during pregnancy only if clearly needed." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Not applicable to pregnancy entry - the patient is a pregnant adult. Any weight-based child dose for this drug belongs on the paediatric urinary tract infection entry.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "FOSFORON 3GM 1 SACHET", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "GLOBE INTERNATIONAL PHARMACEUTICALS", "price_egp": 39.0, "pack_count": null, "unit_price": null, "strength_mg": 3000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "MONURIL 3GM 1 SACHET", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ZAMBON > PHARMACON", "price_egp": 293.0, "pack_count": null, "unit_price": null, "strength_mg": 3000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "uti-in-pregnancy" }, { "id": 1906, "generic": "Pivmecillinam", "line": 2, "is_adjunct": false, "form": "oral.solid", "strength_mg": 200.0, "adult_dose": "The SmPC writes a separate pregnancy regimen, and it is the one to follow. Verbatim, under Pregnant women: \"Acute cystitis: 7 day course of 2 tablets immediately followed by 1 tablet 3 times daily to a total of 22 tablets.\" On 200 mg tablets that is 400 mg as the first dose, then 200 mg three times a day for seven days. The disease article gives a heavier regimen for the same seven days - \"pivmecillinam 400 mg 3 times a day for 7 days for uncomplicated cystitis\" - and the two are printed side by side because they genuinely differ; the label's own pregnancy schedule leads.", "adult_duration": "Seven days, which is the pregnancy course rather than the three-day course used outside pregnancy. The SmPC's non-pregnant regimen is a \"72 hour course\"; the pregnancy entry is a \"7 day course\", and the disease article agrees on seven.", "dose_source": "Selexid 200 mg Film-coated Tablets (pivmecillinam hydrochloride) SmPC sections 4.1, 4.2, 4.3, 4.4 and 4.6 (eMC product 3799)", "rationale": "The disease article names the drug and puts it among the alternative regimens, verbatim: \"Multiple randomized trials support the use of a newer antibiotic, pivmecillinam 400 mg 3 times a day for 7 days for uncomplicated cystitis. Routine use for upper urinary tract infection is not yet recommended.\" The SmPC's indication section names urinary tract infections, and its pregnancy section names the disease and the patient together, verbatim: \"A large amount of data on pregnant women (more than 40 000 pregnancy outcomes) indicate no malformative nor feto/neonatal toxicity of pivmecillinam. Selexid can be used for treatment of acute uncomplicated cystitis during pregnancy, if clinically needed.\" It earns a place because resistance is the reason the card needs depth - the article's own point about pivmecillinam elsewhere is that it covers ESBL-producing organisms. Egypt registers no pivmecillinam product, so no brand and no price can be shown; the row exists so a regimen started abroad can be recognised and continued.", "cautions": [ "Contraindicated in more than the obvious group. SmPC verbatim: \"Hypersensitivity to penicillins and/or cephalosporins. Any conditions resulting in impaired transit through the oesophagus.\" and \"Genetic metabolism anomalies known to be leading to severe carnitine deficiency, such as carnitine transporter defect, methylmalonic aciduria or propionic acidaemia.\"", "Take it upright, with fluid and food. SmPC verbatim: \"The tablets must be taken with at least half a glass of fluid, and preferably taken with or immediately after a meal.\" The oesophageal contraindication above is the reason this instruction carries weight.", "Severe skin reactions end the course. SmPC verbatim: \"Severe cutaneous adverse reactions (SCAR) such as acute generalized exanthematous pustulosis (AGEP), drug reaction with eosinophilia and systemic symptoms (DRESS), Stevens-Johnson syndrome (SJS), and toxic epidermal necrolysis (TEN) have been reported in relation to beta-lactam treatment, including Selexid. When SCAR is suspected, Selexid should be discontinued immediately\".", "It depletes carnitine, and valproate makes that worse. SmPC verbatim: \"Selexid tablets should be used with caution for long-term or frequently-repeated treatment, due to the possibility of carnitine depletion. Symptoms of carnitine depletion include muscle aches, fatigue, and confusion.\" and \"Concurrent treatment with valproic acid, valproate or other medication liberating pivalic acid should be avoided due to increased risk of carnitine depletion.\"", "Caution in porphyria. SmPC verbatim: \"Selexid tablets should be used with caution in patients with porphyria since pivmecillinam has been associated with acute attacks of porphyria.\"", "It can trip the newborn screen. SmPC verbatim: \"The intake of pivmecillinam shortly before delivery may cause a false positive test for isovaleric acidaemia in the newborn as part of neonatal screening. This may be due to the formation of pivaloylcarnitine simulating the presence of isovalerylcarnitine.\" If it was given near term, say so when the baby is screened.", "Breastfeeding is not a reason to withhold it. SmPC verbatim: \"Mecillinam is excreted in human milk, but at therapeutic doses of Selexid no effects on the breast-fed newborns/infants are anticipated. Selexid can be used during breast-feeding.\"", "Not for a kidney infection. The disease article is explicit that it is not yet recommended for routine use in an upper urinary tract infection - fever, flank pain or vomiting in a pregnant patient is a different pathway." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Not applicable to pregnancy entry - the patient is a pregnant adult. Any weight-based child dose for this drug belongs on the paediatric urinary tract infection entry.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [], "condition_id": "uti-in-pregnancy" }, { "id": 1905, "generic": "Nitrofurantoin", "line": 3, "is_adjunct": false, "form": "oral.solid", "strength_mg": 50.0, "adult_dose": "50 to 100 mg once daily at bedtime as continuous prophylaxis", "adult_duration": null, "dose_source": "Egyptian National Drug Formulary - Antimicrobial 2023 (nitrofurantoin monograph, prophylaxis for recurrent cystitis)", "rationale": "A different prescription from the treatment course already on this card: the disease article gives suppressive nitrofurantoin once daily through the remainder of pregnancy for recurrent UTI, and the ENDF has an explicit continuous-prophylaxis dose for recurrent uncomplicated cystitis. Because the same formulary contraindicates the drug from 38 weeks, suppression cannot simply run to delivery - it has to be stopped and, if still needed, replaced.", "cautions": [ "Because of the possibility of hemolytic anemia caused by immature erythrocyte enzyme systems (glutathione instability), the drug is contraindicated in pregnant patients at term (38 to 42 weeks gestation), during labor and delivery, or when the onset of labor is imminent.", "Anuria, oliguria, or significant impairment of renal function (creatinine clearance [CrCl] <60 mL/minute or clinically significant elevated serum creatinine)", "Previous history of cholestatic jaundice or hepatic dysfunction associated with prior nitrofurantoin use; hypersensitivity to drug or any component of the formulation" ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Not applicable - this row is a regimen for pregnancy.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "MACROFURAN 50 MG 30 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "KAHIRA", "price_egp": 51.0, "pack_count": 30, "unit_price": 1.7, "strength_mg": 50.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "MEPAFURAN 50 MG 20 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MEPACO", "price_egp": 34.0, "pack_count": 20, "unit_price": 1.7, "strength_mg": 50.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "uti-in-pregnancy" }, { "id": 1907, "generic": "Paracetamol", "line": 1, "is_adjunct": true, "form": "oral.solid", "strength_mg": 500.0, "adult_dose": "1 g by mouth three to four times a day, to a maximum of 4 g daily", "adult_duration": "While febrile or in pain; stop once the fever settles on antibiotics", "dose_source": "PARACETAMOL = ACETAMINOPHEN oral - MSF Medical Guidelines (Essential drugs), Dosage", "rationale": "Antibiotics treat the infection but do nothing for the fever and loin pain in the first day or two. Paracetamol is the one analgesic and antipyretic that carries no contraindication in pregnancy, so it belongs on a card that otherwise offers only antibiotics. NSAIDs are not an alternative here.", "cautions": [ "Never exceed the daily ceiling, and count in every combination cold, flu or painkiller product the patient may also be taking, because most of them contain paracetamol too.", "Use it cautiously, and consider a lower dose, in a woman with liver disease.", "It brings the temperature down but does not treat the infection - it must never delay or replace the antibiotic.", "Fever with loin pain and rigors in pregnancy points to pyelonephritis, which usually needs admission; treating the fever at home is not enough on its own." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Not applicable - pregnant adults only.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "FEBRIMOL 500 MG 20 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PHARCO", "price_egp": 3.5, "pack_count": 20, "unit_price": 0.17, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "CETAMOL 500 MG 20 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MEMPHIS", "price_egp": 8.0, "pack_count": 20, "unit_price": 0.4, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "PARACETAMOL-MUP 500MG B.P. 20 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MUP", "price_egp": 13.0, "pack_count": 20, "unit_price": 0.65, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "CETAL 500 MG 20 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EIPICO", "price_egp": 24.0, "pack_count": 20, "unit_price": 1.2, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ARKADOLOW 500 MG 30 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "UTOPIA", "price_egp": 42.0, "pack_count": 30, "unit_price": 1.4, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "PARAMOL 500MG 20 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MISR", "price_egp": 38.0, "pack_count": 20, "unit_price": 1.9, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ADOL 500MG 24 CAPLETS", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "JULPHAR", "price_egp": 32.0, "pack_count": null, "unit_price": null, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "AUGICETAMIDE 500 MG 20 SACHETS", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "AUG PHARMA", "price_egp": 50.0, "pack_count": null, "unit_price": null, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "FEBRIMOL ORAL DROPS 20 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PHARCO", "price_egp": 4.0, "pack_count": null, "unit_price": null, "strength_mg": null, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null }, { "trade_name": "THERA-LO 3.2G/100ML ORAL SUSP. 100 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PHAROPHARMA", "price_egp": 5.0, "pack_count": null, "unit_price": null, "strength_mg": 3200.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null } ], "condition_id": "uti-in-pregnancy" } ] }