Shouldnt have eaten the alpaca

October 16, 2010 6:45 PM

Help! In Peru and my pregnant wife has a severe case of food poisoning. The local doctor prescribed Nifurat. Is it safe during pregnancy? He says yes but the internet tells me nothing.

Well, we skipped the inca trail (see here, but things still went south. We are currently stuck in Aquas Calientes and she is hurting pretty bad.

Nifurat is apparently 200mg of nifuroxazida and 350mg of atapulgita.

Any (not my) mefi doctors out there?

posted by pencroft to health & fitness (17 answers total)

You might try calling your hometown's hospital long distance; if wife's primary can be paged through the hospital's directory, that's be a bigger help, but the staff on hand could find someone who'd have an answer.

Best of luck to you both.
posted by Smart Dalek at 7:09 PM on October 16, 2010

I'm finding information on it under the name "Nifuroxazide," but haven't been able to find any data on what category it falls in. Will keep looking, but maybe the alternate name will help?
posted by moira at 7:13 PM on October 16, 2010

Sorry - I meant best to you and your family.
posted by Smart Dalek at 7:15 PM on October 16, 2010

Sent you memail.
posted by These Premises Are Alarmed at 7:18 PM on October 16, 2010

The Reprotox database seems to clear both ingredients, but IANAPharmacist, who is really who you want to consult.
posted by cobaltnine at 7:24 PM on October 16, 2010

Atapulgita may be Kaopectate. (link to reference in google books)
posted by needs more cowbell at 7:32 PM on October 16, 2010

IANAP, but this translated page says your wife should be especially careful (in reference to atapulgita)
posted by cpdavy at 7:35 PM on October 16, 2010

Huh. Oddly, the page I linked to seems to say atapulgita is pregnancy category C ("pertenece a la categoria C de riesgo gestacional") which equals "Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks."

From googling it seems that Kaopectate may not just be kaolin and pectin anymore, but something like Pepto-bismol (bismuth subsalicylate) instead. Kaolin and Pectin are category B, but pepto-bismol seems to be category C (not recommended) due to salicylate absorption.
posted by needs more cowbell at 7:50 PM on October 16, 2010

Call Motherisk

They're the gurus of what substances are safe in pregnancy, and are very helpful with this sort of question.

Motherisk helpline (open 9-5 EST): 416-813-6780

Keep her hydrated!
posted by thelaze at 7:55 PM on October 16, 2010

I can't believe I'm the first one to say this.

If it's truly severe food poisoning, and she's pregnant, she needs to go to the hospital.
posted by makonan at 8:11 PM on October 16, 2010 [6 favorites]

Can you not call her OB/GYN? Do you need a calling card?
posted by IndigoRain at 8:55 PM on October 16, 2010

makonan, the fact that they went to the local doctor (and the wife is hurting badly) makes me think that they would have done so had that been an option.
posted by R a c h e l at 9:04 PM on October 16, 2010

Is it food poisoning food poisoning or is it general travelers' gastro issues that were reported to the local doctor as "food poisoning"?

If the latter - and keep in mind i have NO IDEA how bad it actually is and have never been pregnant before - why not see if it blows over on its own?

The vast majority of international travelers who think they have food poisoning, dysentery, a parasite, or any of a number of serious illnesses really don't have any of those conditions - they just have a garden variety gastric freakout best cured by rest and fluids.

I'd also suggest getting out of Aguas Calientes and heading back to Cusco where there are better doctors, better food, more comfortable conditions, etc. Can she seriously not ride out a couple hours on the train? That doesn't bode well.
posted by Sara C. at 9:10 PM on October 16, 2010

I am not a doctor.

The labeling for Peru doesn't seem to include any information about Nifurat and pregnancy...which is probably why your doctor is saying that it's okay.

Here's the labeling that is used for the same medication in Bolivia, however, and you can see that pregnancy is listed in the section for precautions/warnings:

http://www.bago.com/Bolivia/Medicos/Vademec/Nifurat.htm

The same antibiotic / kaopectate combination is sold in Chile, albeit under a different name, and the labeling specifies:

El uso en el embarazo se debe evaluar de acuerdo a si los posibles beneficios superan los riesgos potenciales.

"Use in pregnancy should be evaluated according to whether the possible benefits outweigh the potential risks."

There's also a version for sale here in Mexico where the labeling lists pregnancy as a contraindication, and "RESTRICCIONES DE USO DURANTE EL EMBARAZO Y LA LACTANCIA: La seguridad de este producto no ha sido establecida."...Restrictions for use during pregnancy and breastfeeding: the security of this product has not been established.
posted by toodles at 9:10 PM on October 16, 2010 [1 favorite]

This antibiotic is not one that's used in the United States, so I can't find much information on what pregnancy category it is. It is probably category C. Most things are category C. Category C means that we do not know if it is dangerous or not, but at least we don't have hard evidence that it's dangerous.

I can tell you that for general traveler's diarrhea, a general guideline is only to treat it with antibiotics if it is bloody or if it lasts for more than a few days (some say a week). Otherwise, you can usually get away with just hydrating and resting. Remember to hydrate with oral hydration solution (which is sort of like a homemade Gatorade, it's got a little salt and sugar in it) instead of just water. Gatorade would work well if you have access to it.

Personally my preference would be to avoid medications like these, that are category C, unless they are truly necessary during pregnancy (particularly the kaopectate since it's just a symptomatic med and not actually getting rid of the problem), and we don't have enough data to know whether that is the case for your wife. I hope that is helpful.
posted by treehorn+bunny at 9:33 PM on October 17, 2010

Update!

First, thank you all so much for your help. Mrs. P and I rarely get in panic mode, but this was one of those times. I've never seen food poisoning act that fast and that violently, let alone feel that helpless about it.

Second, after Mrs. P tried taking an initial dose of the Nifurat that night, it came right back up. We took that as a sign and then focused on waiting and hydration for a good 24 hours until we were able to get a train back to Cusco.

It turns out waiting and hydration was all we needed. She was able to start taking food about 36 hours after onset and we are safely back home in the states. Mrs. P is doing fantastic. Baby P seems just fine as well.

Wow was that scary. This whole "having a baby" panic gets easier, right?
posted by pencroft at 3:00 PM on October 21, 2010

Glad to hear Mrs. and Baby P are well! Get home safe.
posted by ocherdraco at 4:33 AM on October 22, 2010