From the Research
Nitrofurantoin is the preferred antibiotic for UTI prophylaxis during pregnancy, typically prescribed as 100mg daily at bedtime, as recommended by the most recent and highest quality study 1.
Key Points
- Alternatives to nitrofurantoin include cephalexin 250-500mg daily or trimethoprim-sulfamethoxazole, although the latter should be avoided in the first and third trimesters 1.
- Prophylaxis is generally recommended for pregnant women with recurrent UTIs, defined as two or more infections during pregnancy or a history of recurrent UTIs before pregnancy 1.
- Treatment should continue throughout pregnancy and may extend 4-6 weeks postpartum, with regular monitoring using monthly urine cultures to detect breakthrough infections 1.
- Before starting prophylaxis, a urine culture should confirm the absence of active infection, and non-antibiotic measures like adequate hydration, urinating after intercourse, and proper wiping technique should also be encouraged alongside medication 1.
Rationale
The use of nitrofurantoin for UTI prophylaxis during pregnancy is supported by the most recent and highest quality study 1, which recommends a short course of β-lactams, nitrofurantoin, or fosfomycin for the treatment of asymptomatic bacteriuria.
Considerations
While other studies, such as 2, 3, 4, and 5, provide additional information on the treatment of UTIs during pregnancy, the most recent and highest quality study 1 takes precedence in guiding clinical decision-making.
Monitoring and Prevention
Regular monitoring with monthly urine cultures is advised to detect breakthrough infections, and non-antibiotic measures like adequate hydration, urinating after intercourse, and proper wiping technique should also be encouraged alongside medication to prevent UTIs during pregnancy 1.