From the Guidelines
The first-line treatment for an uncomplicated urinary tract infection (UTI) in pregnancy 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 and highest quality evidence available, which prioritizes the safety and efficacy of Nitrofurantoin during pregnancy.
- The European Association of Urology guidelines 1 suggest Nitrofurantoin macrocrystals as a first-line treatment option for uncomplicated cystitis in women, including those who are pregnant.
- The guidelines also recommend Fosfomycin trometamol as a first-line treatment option, but it is only recommended for women with uncomplicated cystitis and is given as a single dose of 3 g 1.
- Other options like Pivmecillinam and Cephalosporins (e.g., cefadroxil) are also available, but Nitrofurantoin remains a preferred choice due to its safety profile and effectiveness against common UTI pathogens like E. coli.
- It is essential to note that certain antibiotics, such as Trimethoprim and Trimethoprim-sulfamethoxazole, should be avoided during pregnancy due to potential fetal risks, as stated in the guidelines 1.
- Prompt treatment of UTIs in pregnancy is crucial to prevent complications like pyelonephritis, which can increase the risk of preterm labor and low birth weight.
- After treatment, a follow-up urine culture is recommended to confirm resolution of the infection, and increased fluid intake and urinating frequently can help support treatment and prevent recurrence.
From the Research
First-Line Treatment for Uncomplicated UTI in Pregnancy
- The first-line treatment for uncomplicated urinary tract infections (UTI) in pregnancy includes nitrofurantoin, fosfomycin, and trimethoprim-sulfamethoxazole (when resistance levels are <20%) 2, 3, 4.
- Nitrofurantoin is a widely used antibiotic for treating UTIs, especially in pregnancy, due to its effectiveness against common uropathogens and low resistance rates 5, 4.
- Fosfomycin is also recommended as a first-line agent for uncomplicated cystitis in pregnancy, with a low risk of resistance and minimal collateral damage 2, 3, 4.
- Trimethoprim-sulfamethoxazole can be used in pregnancy, but its use is limited to areas with low resistance rates (<20%) 3, 4.
- Asymptomatic bacteriuria should be treated in pregnancy to prevent complications, and urine culture is the gold standard for detection of UTI 6, 4.
Considerations for Antibiotic Choice
- The choice of antibiotic should be based on individual patient risk factors, prior antibiotic treatment, and local resistance patterns 3, 6, 4.
- Fluoroquinolones are not recommended as first-line agents for uncomplicated UTI in pregnancy due to increasing resistance rates and potential collateral damage 3, 6.
- Beta-lactams can be used in pregnancy, but their effectiveness may be limited by increasing resistance rates 4.