From the Guidelines
Treatment of Urinary Tract Infection (UTI) in pregnancy should always be done to prevent complications such as pyelonephritis and preterm labor.
Treatment Options
- Antimicrobials: such as nitrofurantoin and β-lactam antimicrobials (usually ampicillin or cephalexin) are preferred due to their safety in pregnant women 1, 2.
- Duration of Treatment: a 4- to 7-day duration of antimicrobial therapy is recommended, although the optimal duration may be antimicrobial-specific 2.
- Specific Regimens: + Nitrofurantoin: 50–100 mg four times a day for 5 days or 100 mg twice a day for 5 days 3. + Cephalexin: 500 mg twice a day for 3 days, if the local resistance pattern for Escherichia coli is <20% 3.
Important Considerations
- Screening: pregnant women should be screened for bacteriuria by urine culture at least once in early pregnancy 4, 5.
- Diabetic Women: screening for or treatment of asymptomatic bacteriuria in diabetic women is not indicated, as there is no benefit and potential harm 5.
- Trimethoprim and Trimethoprim-sulfamethoxazole: should be avoided in the first trimester and last trimester of pregnancy, respectively 3.
From the Research
Treatment Options for Urinary Tract Infection (UTI) in Pregnancy
The treatment options for UTI in pregnancy include:
- Antibiotic therapy, with the choice of antibiotic depending on the severity and type of UTI 6, 7, 8, 9
- For asymptomatic bacteriuria (ASB), a short course of β-lactams, nitrofurantoin, or fosfomycin is recommended 6
- For acute pyelonephritis, preferred antimicrobials include amoxicillin combined with an aminoglycoside, third-generation cephalosporins, or carbapenems 6, 8
- For upper UTIs, second-generation cephalosporins are suggested as the first option for empirical antimicrobial management, with aminoglycosides and third-generation cephalosporins as alternative options 8
- Oral antibiotic therapy, such as nitrofurans, fosfomycin trometamol, and third-generation cephalosporins, is recommended for uncomplicated UTIs 9
Antibiotic Therapy
Antibiotic therapy is the basis for the treatment of UTIs in pregnancy, with the goal of preventing complications and promoting a healthy outcome for both the mother and the fetus 6, 7, 8, 9
- The choice of antibiotic depends on the severity and type of UTI, as well as the presence of any underlying medical conditions or allergies 6, 7, 8
- Antibiotic therapy should be guided by urine culture results and sensitivity testing, when possible 8
Management of Upper UTIs
The management of upper UTIs in pregnancy involves:
- Initial management in a hospital setting 8
- Empirical antimicrobial therapy with second-generation cephalosporins, aminoglycosides, or third-generation cephalosporins 8
- Modification of therapy based on urine culture results and sensitivity testing 8
- Switching to oral antimicrobial therapy after at least 48 hours of parenteral therapy, when clinically indicated 8
- Administration of antibiotic therapy for a period of 7 to 10 days, depending on the severity of the infection and the presence of any complications 8