Reeves D S
Department of Medical Microbiology, Southmead Hospital, Westbury-on-Trym, GB-Bristol, UK.
Infection. 1992;20 Suppl 4:S313-6. doi: 10.1007/BF01710022.
Bacteriuria in pregnancy occurs in about one in 20 pregnant women and is usually initially asymptomatic. It is an important marker for acute symptomatic infection (often pyelonephritis) later in pregnancy, which occurs in about one in four bacteriurics. Several considerations surround the antibiotic treatment of the asymptomatic infection; these include a low frequency of in vitro resistance to the agent used, lack of toxicity to the foetus, a low incidence of gastrointestinal side effects, good compliance and proven efficacy. Fosfomycin trometamol seems to fit these requirements. In three controlled studies (two multicentric) 250 patients were treated with fosfomycin trometamol in a 3 g (as fosfomycin) single dose; 197 patients were given one of three other agents. Cure rates for fosfomycin trometamol were 77-94% (68-94% for other agents), which was satisfactory in an infection which is sometimes difficult to eradicate. Further studies are needed in this important but accessible group of patients. Opportunities should be taken to study more foetal outcomes and provide more data on gastro-intestinal tolerability.
孕期菌尿症在约每20名孕妇中就有1例发生，通常起初并无症状。它是孕期后期急性症状性感染（常为肾盂肾炎）的一个重要标志，约四分之一菌尿症患者会出现这种情况。对于无症状感染的抗生素治疗存在几个需要考虑的因素；这些因素包括对所用药物体外耐药频率低、对胎儿无毒性、胃肠道副作用发生率低、依从性好以及疗效已得到证实。磷霉素氨丁三醇似乎符合这些要求。在三项对照研究（两项多中心研究）中，250例患者接受了3克（以磷霉素计）单剂量的磷霉素氨丁三醇治疗；197例患者接受了其他三种药物中的一种治疗。磷霉素氨丁三醇的治愈率为77% - 94%（其他药物为68% - 94%），在这种有时难以根除的感染中这一治愈率是令人满意的。对于这一重要但易治疗的患者群体还需要进一步研究。应该抓住机会研究更多胎儿结局，并提供更多关于胃肠道耐受性的数据。
