From the Guidelines
Pregnant women with recurrent urinary tract infections (UTIs) should be treated with antibiotics that are safe during pregnancy, such as nitrofurantoin or cephalexin, for 5-7 days, and screened for asymptomatic bacteriuria throughout pregnancy. The treatment of recurrent UTIs in pregnancy is crucial to prevent complications for both mother and baby, including pyelonephritis, preterm labor, and low birth weight 1. According to the European Association of Urology guidelines, pregnant women with asymptomatic bacteriuria should be screened for and treated with standard short-course treatment or single-dose fosfomycin trometamol 1.
Treatment Options
- Nitrofurantoin (100mg twice daily for 5-7 days) is a commonly used antibiotic for treating UTIs in pregnancy, but it should be avoided in the first trimester and near delivery 1.
- Cephalexin (500mg four times daily for 5-7 days) is another option for treating UTIs in pregnancy.
- Amoxicillin-clavulanate (500mg/125mg twice daily for 5-7 days) can also be used, but the choice of antibiotic should be guided by culture results and local resistance patterns, with adjustments made based on the trimester of pregnancy.
Prevention Strategies
- Daily low-dose antibiotic prophylaxis, such as nitrofurantoin 50-100mg daily or cephalexin 250-500mg daily, may be recommended to prevent recurrent UTIs in pregnancy.
- Pregnant women should increase fluid intake to at least 2-3 liters daily, urinate frequently, practice proper hygiene (wiping front to back), urinate before and after intercourse, and consider cranberry products (though evidence is limited) 1.
- Regular urine cultures should be performed to monitor for asymptomatic bacteriuria, which requires treatment during pregnancy.
Importance of Treatment
Recurrent UTIs in pregnancy can lead to serious complications if left untreated, including pyelonephritis, preterm labor, and low birth weight 1. Therefore, it is essential to treat these infections aggressively and monitor for asymptomatic bacteriuria throughout pregnancy. The choice of antibiotic and treatment duration should be guided by the most recent and highest quality evidence, such as the European Association of Urology guidelines 1.
From the FDA Drug Label
To reduce the development of drug-resistant bacteria and maintain the effectiveness of sulfamethoxazole and trimethoprim oral suspension and other antibacterial drugs, sulfamethoxazole and trimethoprim oral suspension should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria For the treatment of urinary tract infections due to susceptible strains of the following organisms: Escherichia coli, Klebsiella species, Enterobacter species, Morganella morganii, Proteus mirabilis and Proteus vulgaris
The treatment for recurrent UTI in pregnancy is not explicitly stated in the provided drug labels. Pregnancy is not mentioned as a specific consideration for the use of trimethoprim/sulfamethoxazole.
- The labels provide dosage information for adults and children, but do not address the treatment of UTIs in pregnant women.
- The labels do mention the treatment of urinary tract infections, but do not provide guidance on the management of recurrent UTIs in pregnancy. 2 2
From the Research
Treatment Options for Recurrent UTI in Pregnancy
- Postcoital prophylaxis with a single oral dose of either cephalexin (250 mg) or nitrofurantoin macrocrystals (50 mg) has been shown to be effective in preventing recurrent UTIs during pregnancy 3
- Nitrofurantoin 50 mg daily prophylaxis is recommended over 100 mg due to its equivalent effectiveness and better safety profile 4
- Pharmacologic and nonpharmacologic interventions, including increased interest in the urinary microbiome, are being explored for the diagnosis, treatment, and prevention of recurrent UTIs 5
Antibiotic Resistance and Treatment
- Antibiotics such as amoxicillin/clavulanate, cefdinir, cefuroxime, and nitrofurantoin have been found to have lower resistance rates and may be effective alternatives for treating UTIs 6
- Nitrofurantoin is a commonly prescribed antibiotic for outpatient treatment of UTI/cystitis and has a favorable resistance profile 6
- Amoxicillin-clavulanate may be a useful alternative therapy for the treatment of ceftriaxone non-susceptible Enterobacterales UTIs 7