Case study: Use of trimethoprim in women of child-bearing age

Through its core work to review recorded patient safety events, the National Patient Safety Team identified an issue relating to the prescribing of trimethoprim, an antibiotic commonly used to treat urinary tract infections, in patients who could become pregnant. Taking this medicine in early pregnancy can result in spinal cord malformation in the foetus.

An incident report described a patient becoming pregnant whilst taking trimethoprim to prevent a recurring urinary tract infection. The patient continued to take the medication for several weeks of her pregnancy before it was discontinued.

Whilst there is detailed information available in key resources regarding use of trimethoprim in pregnancy, information on the risk to people who could become pregnant is less clear.
We raised these concerns with the Medicines and Healthcare products Regulatory Agency (MHRA) who acknowledged inconsistencies in product information regarding advice to avoid pregnancy during treatment; the MHRA agreed to include trimethoprim in a review of this information.

NICE also agreed to revise their Patient Decision Aid (NG112) Reducing the chance of recurrent urinary tract infection (UTI) in premenopausal women who are not pregnant to include the statement “Some antibiotics are best avoided in pregnancy. Speak to your healthcare professional if you are pregnant, could be pregnant or you are trying for a baby”.

About our patient safety review and response work

The recording and central collection of patient safety events to support learning and improvement is fundamental to improving patient safety across all parts of NHS healthcare. The National Patient Safety Team identify new or under recognised patient safety risks, which are often not obvious at a local level. It does this through its core work to review patients safety events recorded on national systems, such as the National Reporting and Learning System (NRLS), the new Learn from Patient Safety Events service (LFPSE), and other sources.

In response to any newly identified risks, we develop advice and guidance, such as National Patient Safety Alerts, or work directly with partners as in the example above, to support providers across the NHS to take the necessary action to keep patients safe.

You can find out more about our processes for identifying new and under recognised patient safety issues on our using patient safety events data to keep patients safe and reviewing patient safety events and developing advice and guidance web pages.

You can also find more case studies providing examples of this work on our case study page.