What is the treatment for an uncomplicated urinary tract infection (UTI) in a lactating mother with a newborn?

From the Guidelines

For uncomplicated urinary tract infections (UTIs) in lactating mothers with newborns, nitrofurantoin (100mg twice daily for 5-7 days) is the preferred first-line treatment as it is safe during breastfeeding and has low resistance rates, as noted in the 2018 study 1. When considering treatment options, it's essential to take into account the safety of the antibiotic during breastfeeding and the potential for resistance.

• Nitrofurantoin is a good choice because it has low resistance rates and is considered safe for use during lactation, as supported by the 2011 study 1.
• Trimethoprim-sulfamethoxazole should be avoided if the infant is less than 2 months old due to potential bilirubin displacement.
• Fluoroquinolones like ciprofloxacin are generally not recommended during lactation. The mother should continue breastfeeding during treatment, as only small amounts of these antibiotics pass into breast milk.
• Increased fluid intake, complete emptying of the bladder, and urinating after intercourse can help prevent recurrence. It's crucial to take the full course of antibiotics even if symptoms improve quickly.
• If symptoms worsen or don't improve within 48-72 hours, the mother should contact her healthcare provider as a urine culture may be needed to identify the specific bacteria and appropriate antibiotic, as recommended in the 2011 study 1.

From the FDA Drug Label

1.5 Urinary Tract Infections – caused by beta-lactamase–producing isolates of E. coli, Klebsiella species, and Enterobacter species. The treatment for an uncomplicated urinary tract infection (UTI) in a lactating mother with a newborn may include amoxicillin-clavulanate (PO), as it is indicated for the treatment of urinary tract infections caused by susceptible bacteria, including E. coli, Klebsiella species, and Enterobacter species 2.

• Key considerations:
  • The drug should only be used to treat infections proven or strongly suspected to be caused by susceptible bacteria.
  • Local epidemiology and susceptibility patterns should contribute to the empiric selection of therapy. However, it is essential to consult the healthcare provider for the best course of treatment, as the specific circumstances of the infection and the patient's health status need to be taken into account.

From the Research

Treatment for Uncomplicated Urinary Tract Infection (UTI) in Lactating Mothers

• The treatment for uncomplicated UTI in lactating mothers is similar to that in non-pregnant women, with some considerations for the safety of the newborn 3, 4, 5.
• First-line empiric antibiotic therapy for acute uncomplicated bacterial cystitis in otherwise healthy adult nonpregnant females, which can be applied to lactating mothers, includes:
  • A 5-day course of nitrofurantoin
  • A 3-g single dose of fosfomycin tromethamine
  • A 5-day course of pivmecillinam 4, 5, 6, 7
• It is essential to consider the local susceptibility patterns and the risk of resistance when choosing an antibiotic 4, 7.
• Asymptomatic bacteriuria does not need to be treated, except in exceptional situations such as pregnancy or before urological procedures that will probably injure the mucosa of the urinary tract 3, 7.
• The choice of antibiotic should be based on the patient's individual risk profile, prior antibiotic treatment, the spectrum of pathogens, and antibiotic susceptibility 7.
• High-dose fluoroquinolones are still recommended as first-line oral treatment for uncomplicated pyelonephritis 3, 7.
• It is crucial to use antibiotics wisely to avoid resistance development and to consider the ecological adverse effects of antimicrobial therapy 4, 7.