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Antisettici urinari: di uso molto frequente in gravidanza, meritano un’attenzione particolare.
I sulfamidici rientrano nella categoria C della FDA; possono provocare, se usati nel primo trimestre, schisi facciale, anomalie cardiovascolari, anomalie del tratto urinario. Se invece sono assunti in prossimità del parto, possono provocare ittero neonatal, per competizione recettoriale albuminica con la bilirubina, fino all’ittero nucleare. La sulfasalazina rappresenta un’eccezione, in quanto il suo metabolita attivo nel feto, la sulfapiridina, ha una capacità molto debole di spostare la bilirubina e presenta perciò dei rischi minimi per il feto.
Chinolonici: agiscono interrompendo la replicazione delle molecole del DNA negli agenti patogeni. Vanno evitati in gravidanza perché possono provocare condrodistrofie fetali e ittero neonatale con eritroblastosi per competizione recettoriale con la bilirubina per il legame con l’albumina.
In gravidanza è preferibile utilizzare la fosfomicina, mentre i nitrofurani vanno evitati a termine di gravidanza in quanto possono causare nel feto anemia emolitica.
|
Tab. 8 – Antisettici urinari |
management |
|
|
Fosfomicina |
monuril bustine |
Farmaco di Ia scelta in |
|
sulfamidici |
sulfametossazolo + trimetoprim |
ctg C FDA, metaemoglobinemia, emolisi nelle madri e nei feti affetti da deficit genetico di G6PD, ittero neonatale, schisi facciale, anomalie cardiovascolari |
|
ac. nalidixico |
nalidixin cp |
teratogeni se somministrati <14 settimane anomalie del tratto urinario nel II°-III° trimestre |
|
Nitrofurantoina |
furadantin cpr |
ctg C2; t teratogeni <14 w metemoglobinemia, anemia emolitica nelle madri e nei feti affetti da deficit genetico di G6PD |
|
ac. pipemidico |
pipemid cpr |
ctg C2; teratogeni <14 w |
|
chinolonici |
Enoxacina ( Bactidan, Enoxen) |
ctg C2 della FDA; Condodistrofie fetali Ittero neonatale con eritroblastosi per competizione recettoriale con la bilirubina per il legame con l’albumina |
|
Norfloxacina (Fulgram, Noroxin, Sebercim) |
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Ciprofloxaciclina (ciproxin, Flociprin) |
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Pefloxaciclina (Peflox, Peflacin) |
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Levofloxacina, flucloxacillina (Cloxillin, |
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Ofloxacina (Flobacin, Oflocin) |
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Lomefloxacina (Uniquin cpr, chimono cpr) |
ctg C3; teratogeni <14 w metemoglobinemia, anemia emolitica |
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|
Penicilline semisintetiche |
Mezlocillina (Baypen), Piperacillina |
Ctg B1 |
|
Novobiocina (debole acido bifasico) |
impiegato in alcuni casi di gravi infezioni |
ctg C; ittero in gravidanza |
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