From the Guidelines
During pregnancy, a urinary tract infection (UTI) with more than 50,000 CFU should be treated promptly with antibiotics, specifically nitrofurantoin macrocrystals 50–100 mg four times a day for 5 days, as this represents significant bacteriuria and can lead to serious complications if left untreated 1. The treatment of UTI during pregnancy is crucial to prevent complications such as pyelonephritis, preterm labor, low birth weight, and maternal sepsis.
- The first-line treatment options include:
- Nitrofurantoin macrocrystals 50–100 mg four times a day for 5 days
- Nitrofurantoin monohydrate or macrocrystals 100 mg twice daily for 5 days
- Nitrofurantoin macrocrystals prolonged release 100 mg twice daily for 5 days
- Alternative treatment options include:
- Cephalosporins (e.g., cefadroxil) 500 mg twice daily for 3 days, if the local resistance pattern for Escherichia coli is <20%
- It is essential to avoid trimethoprim-sulfamethoxazole in the first trimester of pregnancy due to potential fetal risks 1.
- Fluoroquinolones like ciprofloxacin are contraindicated during pregnancy.
- After treatment, a follow-up urine culture is recommended to confirm clearance of the infection.
- Untreated UTIs during pregnancy can lead to serious complications, and adequate hydration and urinating after intercourse may help prevent recurrence.
- If recurrent UTIs occur during pregnancy, antibiotic prophylaxis might be considered after consultation with an obstetrician 1.
From the Research
Treatment of Urinary Tract Infections (UTIs) in Pregnancy
UTIs are a common issue during pregnancy, affecting up to 5-7% of women, and can lead to complications for both the mother and the fetus if left untreated 2. The treatment of UTIs in pregnancy typically involves antibacterial therapy (ABT), with the choice of antibiotic depending on the severity of the infection and the stage of pregnancy.
Antibiotic Selection
For uncomplicated UTIs, oral antibiotics such as nitrofurans, fosfomycin trometamol, and third-generation cephalosporins (e.g., cefixime) are recommended due to their high efficacy and safety in pregnant women 2, 3. The selection of an antibiotic should be based on the results of a urine culture to ensure the chosen antibiotic is effective against the specific bacteria causing the infection 4.
Treatment Regimens
Some studies recommend the following treatment regimens for UTIs in pregnancy:
- A single dose of an antimicrobial agent for asymptomatic bacteriuria 5
- Amoxicillin 500 mg tid for three days for symptomatic UTIs 5
- Postcoital prophylaxis with a single oral dose of cephalexin (250 mg) or nitrofurantoin macrocrystals (50 mg) for women with a history of recurrent UTIs 3
Key Considerations
When treating UTIs in pregnancy, it is essential to consider the following:
- The risk of ascending infection and the potential for complications for both the mother and the fetus
- The need for timely diagnosis and treatment to prevent adverse outcomes
- The importance of selecting an antibiotic that is safe for use during pregnancy and effective against the specific bacteria causing the infection
- The need for follow-up urine cultures to assess the effectiveness of treatment and detect any potential resistance to the chosen antibiotic 6, 4