From the Guidelines
Azithromycin is the preferred antibiotic for treating both urinary tract infections (UTIs) and chlamydia during pregnancy, as it effectively treats chlamydia and can address some UTI pathogens. For chlamydia, the recommended regimen is azithromycin 1 gram orally as a single dose, as outlined in the 2024 study 1. For UTIs in pregnancy, first-line options include amoxicillin-clavulanate (500/125 mg orally three times daily for 3-7 days), cephalexin (500 mg orally four times daily for 3-7 days), or nitrofurantoin (100 mg orally twice daily for 5-7 days, but avoid in late pregnancy). Some key points to consider when treating UTIs and chlamydia in pregnancy include:
- The importance of completing the full course of antibiotics even if symptoms improve, to ensure complete resolution of both infections.
- The need to drink plenty of water and return for follow-up testing to confirm the infections have been fully treated.
- The potential risks of untreated infections, including pyelonephritis, preterm labor, and vertical transmission of chlamydia to the newborn.
- The safety of certain antibiotics in pregnancy, such as cephalexin, azithromycin, and clindamycin, as reported in the 2025 study 1.
- The need to avoid fluoroquinolones and tetracyclines during pregnancy due to potential fetal risks. It is essential to consult with an obstetrician to select appropriate antibiotics based on culture results and susceptibility testing, especially when treating both conditions simultaneously.
From the Research
Antibiotic Options for UTIs and Chlamydia in Pregnancy
- The treatment of urinary tract infections (UTIs) and Chlamydia in pregnancy requires careful consideration of the antibiotic options to ensure efficacy and safety for both the mother and the fetus.
- For UTIs, the recommended first-line empiric antibiotic therapy includes nitrofurantoin, fosfomycin tromethamine, or pivmecillinam 2.
- However, for Chlamydia treatment in pregnancy, studies suggest that azithromycin and amoxicillin are effective options 3, 4, 5.
- Azithromycin has been shown to be a well-tolerated and effective single-dose treatment for Chlamydia in pregnancy, with a lower rate of gastrointestinal side effects compared to erythromycin 6, 5.
- Amoxicillin has also been found to be effective in treating Chlamydia in pregnancy, with similar efficacy to azithromycin 3, 4.
Considerations for Antibiotic Choice
- The choice of antibiotic should be based on the severity of the infection, the presence of any underlying medical conditions, and the potential for antibiotic resistance 2.
- It is essential to consider the safety profile of the antibiotic during pregnancy and the potential risks to the fetus.
- The treatment of UTIs and Chlamydia in pregnancy should be guided by current clinical guidelines and the results of susceptibility testing, when available.
Available Evidence
- Studies have demonstrated the efficacy of azithromycin and amoxicillin in treating Chlamydia in pregnancy 3, 4, 5.
- The use of nitrofurantoin, fosfomycin tromethamine, and pivmecillinam for UTIs has been recommended, but their effectiveness against Chlamydia is not well established 2.
- Further research is needed to determine the optimal antibiotic regimen for the treatment of UTIs and Chlamydia in pregnancy.