The use of metronidazole during pregnancy is controversial, especially during the first trimester. The CDC also recommends against metronidazole use during the 1st trimester for the treatment of trichomoniasis; use in the 2nd and 3rd trimesters may be acceptable if other treatments have failed. For other indications, metronidazole should be avoided during pregnancy whenever possible, with use occurring only after careful assessment of the potential risk: benefit ratios. Metronidazole is mutagenic in vitro and carcinogenic in rodents, but these concerns have not been shown in humans.
Nitrofurantoin is contraindicated in pregnancy at term (38—42 weeks gestation) and during labor or obstetric delivery. Although it is classified as a pregnancy category B drug for use during pregnancy, nitrofurantoin can induce hemolytic anemia in G6PD-deficient patients and in patients whose RBCs lack sufficient quantities of reduced glutathione. Because neonates exhibit this latter condition, generally it is wise to avoid the use of this drug during late pregnancy; however, hemolytic anemia in the newborn as a result of in utero exposure to nitrofurantoin has not been reported. Metronidazole and Nitrofurantoin do not interact with each other.
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