Rational use of antimicrobials in obstetric practice in view of growing antibiotic resistance

Abstract

Background. Urogenital infections are a leading risk factor for isthmic-cervical insufficiency and preterm labor, and the main role in most cases is played by representatives of opportunistic microflora. The most frequent forms of genital infections are bacterial vaginosis, vulvovaginal candidiasis and urogenital trichomoniasis. Bacterial vaginosis is essentially a manifestation of vaginal dysbiosis, it is not lifethreatening, but it is a risk factor for serious complications among pregnant women, namely, it increases the risk of spontaneous abortion, premature labor, premature rupture of fetal membranes, low birth weight and is a co-factor of persistent genital infections. Given the impact of infectious diseases on the course and outcome of pregnancy, as well as the limited possibilities of therapy during pregnancy, it is important to conduct pregravidarial preparation, including screening of infectious diseases, but over 40% of pregnancies are unplanned, which significantly increases the risks of complications of pregnancy and labor, intrauterine infection of the fetus and newborn.Conclusion. Infectious and inflammatory diseases are an important problem of modern obstetrics and gynecology, especially of rational antimicrobial therapy in conditions of the widespread pathogens’ resistance. The local application of vaginal suppositories Limenda is effective for vulvovaginal treatment in such cases. Furthermore, systemic antibacterial therapy is necessary, spiramycin is very useful in case jozamicin`s withdrawal from the market by Russian Ministry of Health (No. 25-6/159 dated 03/14/24). Macrolide Doramitcin WM is applicable from the first trimester of pregnancy and allows equivalent replacement of the departed 16-membered macrolide.

Keywords

• bacterial vaginosis
• pregnancy
• macrolides
• toxoplasmosis
• pelvic inflammatory diseases