Antibiotics Dispensed to Privately Insured Pregnant Women with Urinary Tract Infections - United States, 2014

Abstract

Urinary tract infections (UTIs) occur in about 8% of pregnant women, and untreated UTIs can have serious consequences, including pyelonephritis, preterm labor, low birth weight, and sepsis (1). Pregnant women are typically screened for UTIs during early pregnancy, and those with bacteriuria are treated with antibiotics (1,2). Antibiotic stewardship is critical to improving patient safety and to combating antibiotic resistance. Because of the potential risk for birth defects, including anencephaly, heart defects, and orofacial clefts, associated with use of sulfonamides and nitrofurantoin during pregnancy (3), a 2011 committee opinion from the American College of Obstetricians and Gynecologists (ACOG) recommended that sulfonamides and nitrofurantoin may be prescribed in the first trimester of pregnancy only when other antimicrobial therapies are deemed clinically inappropriate (4). To assess the effects of these recommendations, CDC analyzed the Truven Health MarketScan Commercial Database* to examine antibiotic prescriptions filled by pregnant women with UTIs. Among 482,917 pregnancies in 2014, 7.2% of women had an outpatient UTI diagnosis during the 90 days before the date of last menstrual period (LMP) or during pregnancy. Among pregnant women with UTIs, the most frequently prescribed antibiotics during the first trimester were nitrofurantoin, ciprofloxacin, cephalexin, and trimethoprim-sulfamethoxazole. Given the potential risks associated with use of some of these antibiotics in early pregnancy and the potential for unrecognized pregnancy, women's health care providers should be familiar with the ACOG recommendations and consider the possibility of early pregnancy when treating women of reproductive age.

FIGURE 1

Selection of study sample of women with pregnancies in 2014 who had sufficient enrollment in a plan with prescription drug coverage and had an outpatient claim for at least one urinary tract infection (UTI) diagnosis — Truven Health MarketScan Commercial Database, United States, 2013–2015 Abbreviation: LMP = date of last menstrual period. * Sufficient enrollment was defined as continuous enrollment from 3 months before date of LMP through the end of pregnancy or missing only 1 month during that period. All others were considered to have insufficient enrollment. ^† UTIs were defined as presence of an International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9 CM) diagnosis code of UTI (599.0) or acute cystitis (595.0 or 595.9) on at least one outpatient claim.

FIGURE 2

Antibiotic medication types filled from outpatient pharmacies among women who were pregnant in 2014, had an outpatient claim for at least one urinary tract infection (UTI) diagnosis,† and filled a prescription for an antibiotic, by period before and during pregnancy — Truven Health MarketScan Commercial Database, United States, 2013–2015 Abbreviation: LMP = date of last menstrual period. * Defined as the first antibiotic prescription(s) filled from an outpatient pharmacy within 7 days of UTI diagnosis. Women with a prescription filled for more than one type of antibiotic during a given period were classified as filling prescriptions for multiple antibiotic types. ^† UTIs were defined as presence of an International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9 CM) diagnosis code of UTI (599.0) or acute cystitis (595.0 or 595.9) on at least one outpatient claim.