From the Guidelines
The first-line treatment for uncomplicated urinary tract infections (UTIs) in pregnant women is nitrofurantoin macrocrystals 100 mg orally twice daily for 5 days, as recommended by the European Association of Urology guidelines 1. This recommendation is based on the most recent guidelines, which prioritize the safety and efficacy of antimicrobial therapy regimens for uncomplicated cystitis in pregnant women.
- The European Association of Urology guidelines suggest nitrofurantoin macrocrystals as a first-line treatment option, with a daily dose of 100 mg orally twice daily for 5 days 1.
- Other options, such as fosfomycin trometamol and pivmecillinam, are also recommended, but nitrofurantoin macrocrystals are preferred due to their established safety profile during pregnancy.
- It is essential to note that trimethoprim-sulfamethoxazole should be avoided in the first trimester of pregnancy, and cephalosporins, such as cefadroxil, can be used as an alternative, but only if the local resistance pattern for Escherichia coli is <20% 1.
- Pregnant women with UTIs require prompt treatment to prevent complications, such as pyelonephritis, which can increase the risk of preterm labor and low birth weight.
- Adequate hydration and complete adherence to the full antibiotic course should be emphasized to the patient, and follow-up urine cultures after treatment completion are recommended to ensure resolution of the infection.
From the Research
Uncomplicated UTI Treatment in Pregnant Women
- The recommended first-line empiric antibiotic therapy for acute uncomplicated bacterial cystitis in otherwise healthy adult nonpregnant females is a 5-day course of nitrofurantoin, a 3-g single dose of fosfomycin tromethamine, or a 5-day course of pivmecillinam 2.
- However, for pregnant women, the treatment options may differ due to the risk of maternal and fetal complications.
- International guidelines recommend a single screen-and-treat approach to asymptomatic bacteriuria (ASB) in pregnant women, and treatment options include a short course of β-lactams, nitrofurantoin, or fosfomycin 3.
- For cystitis during pregnancy, the preferred treatment options are not well established, but studies suggest that nitrofurantoin, fosfomycin, or β-lactams may be used 3.
- Acute pyelonephritis in pregnancy has been shown to be associated with increased maternal complications, and preferred antimicrobials for management include amoxicillin combined with an aminoglycoside, third-generation cephalosporins, or carbapenems 3.
Guideline Concordance and Prescribing Practices
- A study found that the overall concordance rate with Infectious Diseases Society of America guidelines for the treatment of uncomplicated urinary tract infections in women was 58.4%, with an increase from 48.2% in 2015 to 64.6% in 2019 4.
- The most commonly prescribed antibiotic agents were fluoroquinolones, nitrofurantoin, and trimethoprim-sulfamethoxazole, with fluoroquinolone use decreasing and nitrofurantoin and beta-lactam use increasing from 2015 to 2019 4.
- Patient and physician characteristics, such as age and specialty, were found to be independent predictors of antibiotic selection and guideline concordance 4.
Treatment Options for Uncomplicated UTI in Pregnant Women
- Based on the available evidence, the first-line treatment options for uncomplicated UTI in pregnant women include:
- Nitrofurantoin
- Fosfomycin
- β-lactams (such as amoxicillin or cephalexin)
- These treatment options should be chosen based on the patient's medical history, allergy status, and local resistance patterns 2, 3.