Abstract
BACKGROUND: Antimicrobial therapy during pregnancy is vital for managing infections and protecting maternal-fetal health. However, altered pharmacokinetics and potential teratogenicity complicate prescription, necessitating strict adherence to clinical guidelines. This study assessed the appropriateness of antimicrobial prescriptions among pregnant women in Tabuk, Saudi Arabia and examined demographic factors associated with prescribing practices, as well as the incidence of adverse effects. METHODS: A retrospective cross-sectional observational study was conducted in the outpatient antenatal clinics of three government hospitals in Tabuk, Saudi Arabia, from October 2022 to September 2023, focusing on pregnant women. Data on patient demographics (age, education, employment, parity), clinical details (gestational age, infection type), and antimicrobial prescriptions (drug, dose, duration, trimester) were extracted and evaluated for compliance with American College of Obstetricians and Gynecologists (ACOG) and Health Service Executive (HSE) guidelines. Documented adverse drug reactions were categorized by type and severity. Associations between infection type and antimicrobial prescription appropriateness were evaluated using Chi-square tests. Associations between demographic variables and antimicrobial prescription appropriateness were evaluated using multivariate analysis, with odds ratios (ORs) and 95% confidence intervals (CIs) calculated for categorical variables. Statistical significance was set at p < 0.05. Data were analyzed using SPSS version 27. RESULTS: A total of 403 medical records were analyzed. Urinary tract infections were the most frequent indication (38%), followed by respiratory infections (22.1%) and bacterial vaginosis (14.1%). Amoxicillin and nitrofurantoin were the most prescribed antimicrobials. Overall, 77.4% of prescriptions were guideline-compliant, while 22.6% were inappropriate, predominantly due to incorrect drug selection for the trimester or infection type (9.4%), dosing errors (7.2%), and inappropriate duration (6.0%). Notably, the use of nitrofurantoin in the third trimester and trimethoprim in the first trimester were common concerns. Adverse effects occurred in 14.9% of the patients, with two cases of suspected nitrofurantoin-associated hemolytic anemia. No significant association was observed between infection type and appropriateness of antimicrobial prescription. Educational status was significantly associated with appropriate prescription (aOR: 1.82; 95% CI: 1.05-3.15; p = 0.038), whereas maternal age, employment status, and gestational trimester were not significant predictors. CONCLUSION: Most antimicrobial prescriptions during pregnancy were guideline-compliant, though notable errors, particularly involving nitrofurantoin and trimethoprim, persisted. Higher maternal education was associated with greater likelihood of receiving appropriate prescriptions. These findings highlight the importance of adhering to trimester-specific prescribing guidelines, implementing antimicrobial stewardship measures, and providing ongoing education for healthcare providers to enhance maternal and fetal safety.