What is the treatment for Urinary Tract Infection (UTI) in pregnancy?

From the Guidelines

Urinary tract infections (UTIs) during pregnancy should be treated with a 5-7 day course of oral antibiotics, such as nitrofurantoin or amoxicillin, to prevent complications like pyelonephritis and preterm labor. The choice of antibiotic should be guided by the spectrum and susceptibility patterns of the aetiological pathogens, efficacy for the particular indication in clinical studies, tolerability and adverse reactions, adverse ecological effects, and costs and/or availability 1.

Treatment Options

• Nitrofurantoin (100mg twice daily) is commonly prescribed except in the first trimester and near delivery due to concerns about fetal hemolytic anemia.
• Amoxicillin (500mg three times daily) or amoxicillin-clavulanate (875/125mg twice daily) are good alternatives.
• Cephalexin (500mg four times daily) is also safe throughout pregnancy.
• Fosfomycin (3g single dose) offers convenient treatment with good safety profile, but its use in pregnancy is not well studied 1.

Important Considerations

• Trimethoprim-sulfamethoxazole should be avoided in the first and third trimesters due to risks of neural tube defects and neonatal hyperbilirubinemia.
• Fluoroquinolones and tetracyclines are contraindicated during pregnancy.
• Patients should complete the full antibiotic course even if symptoms resolve quickly, increase fluid intake, and undergo follow-up urine culture after treatment to confirm resolution.
• Recurrent UTIs may require prophylactic antibiotics.
• Asymptomatic bacteriuria should also be treated during pregnancy as it increases the risk of developing symptomatic UTIs and associated complications 1.

Diagnosis and Follow-up

• A urine culture is recommended for pregnant women with suspected UTI, as well as for those with symptoms that do not resolve or recur within 4 weeks after completion of treatment 1.
• Routine post-treatment urinalysis or urine cultures are not indicated for asymptomatic patients, but should be performed for women whose symptoms do not resolve by the end of treatment, and for those whose symptoms resolve but recur within 2 weeks 1.

From the FDA Drug Label

Mild to Moderate Uncomplicated or Complicated Urinary Tract Infections, including pyelonephritis, due to E. coli, K. pneumoniae, or P. mirabilis† 0. 5 to 1 gIV/IM¶ Every 12 hours 7 to 10 Severe Uncomplicated or Complicated Urinary Tract Infections, including pyelonephritis, due to E. coli or K. pneumoniae† 2 g IV Every 12 hours 10

The treatment for Urinary Tract Infection (UTI) in pregnancy is not directly addressed in the provided drug label. However, based on the available information, the recommended dosage for uncomplicated or complicated UTIs is:

• Mild to Moderate: 0.5 to 1 g IV/IM every 12 hours for 7 to 10 days
• Severe: 2 g IV every 12 hours for 10 days It is essential to note that the label does not provide specific guidance for pregnant patients. Therefore, the treatment should be determined by a healthcare professional, considering the patient's individual needs and the potential risks and benefits of the medication 2.

From the Research

Treatment for Urinary Tract Infection (UTI) in Pregnancy

• The recommended treatment for UTI in pregnancy involves separating pregnant subjects with UTI into two groups: those with asymptomatic bacteriuria and those with symptomatic UTI 3.
• For asymptomatic bacteriuria, a single dose of an antimicrobial to which the organism is susceptible can be used 3.
• For symptomatic UTI, amoxicillin 500 mg tid for three days is recommended, with urine cultures repeated seven days following therapy to assess cure or failure 3.
• Other treatment options, such as nitrofurantoin, fosfomycin, and pivmecillinam, may also be effective, but the choice of antibiotic should be based on the patient's individual risk profile, prior antibiotic treatment, and the spectrum of pathogens and antibiotic susceptibility 4, 5.
• It is essential to use antibiotics wisely to avoid resistance development, especially in cases of multidrug-resistant organisms 4.

Antibiotic Options

• Amoxicillin: 500 mg tid for three days 3.
• Nitrofurantoin: 100 mg four times daily for three days 6 or 100 mg three times a day for 5 days 7.
• Fosfomycin: a single 3-g dose 7.
• Pivmecillinam: recommended as first-line treatment for uncomplicated cystitis 5.
• Trimethoprim/sulfamethoxazole: provides cure rates of greater than 80 percent, but its use is limited due to high rates of resistance 3, 4.

Considerations

• The choice of antibiotic should be based on the patient's individual risk profile, prior antibiotic treatment, and the spectrum of pathogens and antibiotic susceptibility 4, 5.
• Asymptomatic bacteriuria should only be treated in exceptional situations, such as pregnancy or before urological procedures that will probably injure the mucosa of the urinary tract 5.
• Urine cultures should be repeated seven days following therapy to assess cure or failure 3.