Treatment of Urinary Tract Infections During Second Trimester of Pregnancy
For urinary tract infections during the second trimester of pregnancy, nitrofurantoin or cephalexin are recommended as first-line treatments due to their safety and efficacy profiles. 1
First-Line Treatment Options
Recommended Antibiotics
Nitrofurantoin: 100 mg twice daily for 5-7 days
- Safe during second trimester
- Achieves high urinary concentrations
- Low resistance rates
- Note: Should be avoided in first and third trimesters 2
Cephalexin: 500 mg four times daily for 5-7 days
- Safe throughout pregnancy
- Effective against most uropathogens
- Good safety profile
Alternative Options
Amoxicillin-clavulanate: 500/125 mg twice daily for 3-7 days
- Broader spectrum option when resistance is a concern
- May cause gastrointestinal side effects 3
Cefpodoxime: 100 mg twice daily for 3-7 days
- Alternative cephalosporin option
- Twice-daily dosing may improve compliance 1
Treatment Duration and Follow-Up
- Uncomplicated UTI: 5-7 days of treatment
- Complicated UTI or pyelonephritis: 10-14 days of treatment 1
- Obtain urine culture before initiating treatment when possible
- Follow-up urine culture 1-2 weeks after completing therapy to ensure cure
Special Considerations
Medications to Avoid
- Trimethoprim-sulfamethoxazole: Should be avoided during pregnancy, particularly in first and third trimesters due to risk of neural tube defects and kernicterus 1
- Fluoroquinolones: Contraindicated during pregnancy due to potential fetal harm 1
- Tetracyclines: Contraindicated during pregnancy due to effects on fetal bone and teeth development 1
Management Approach
- Confirm diagnosis with urinalysis and urine culture when possible
- Select appropriate antibiotic based on:
- Local resistance patterns
- Patient allergies
- Previous culture results (if available)
- Complete full course of antibiotics even if symptoms resolve
- Monitor for symptom resolution within 48-72 hours
Prevention of Recurrent UTIs in Pregnancy
For pregnant women with history of recurrent UTIs:
- Consider postcoital prophylaxis with cephalexin (250 mg) or nitrofurantoin (50 mg) after sexual activity 4
- Increase fluid intake
- Urinate before and after sexual activity
- Maintain good perineal hygiene
Important Caveats
- Untreated UTIs during pregnancy can lead to pyelonephritis, preterm labor, and other serious complications 5
- Do not treat asymptomatic bacteriuria except during pregnancy, when treatment is recommended to prevent complications 1
- Antibiotic selection should consider local resistance patterns
- Pregnant women should not be denied appropriate treatment for UTIs, as untreated infections pose greater risks than properly selected antibiotics 2
Remember that prompt and appropriate treatment of UTIs during pregnancy is essential to prevent complications that could affect both maternal and fetal outcomes.