Treatment of Urinary Tract Infections in Pregnancy
For pregnant women with UTIs, first-line treatment should be nitrofurantoin, fosfomycin trometamol, or cephalosporins (particularly cefixime) for 5-7 days, with treatment guided by urine culture results. 1
Diagnosis and Screening
- A urine culture should be performed in all pregnant women with UTI symptoms to confirm diagnosis and guide appropriate antibiotic selection 1
- Pregnant women should be screened for and treated for asymptomatic bacteriuria, as this is considered a complicated UTI during pregnancy 2
- UTIs occur in approximately 5-7% of pregnant women and require prompt treatment to prevent complications for both mother and fetus 3
First-Line Treatment Options
- Nitrofurantoin (100 mg twice daily for 5 days) is safe and effective in pregnancy but should be avoided in the last trimester due to risk of hemolytic anemia in the newborn 1, 2
- Fosfomycin trometamol (3g single dose) offers convenient administration and comparable efficacy to multi-day regimens 1, 4
- Cephalosporins, particularly cefixime, are excellent options when resistance to other agents is suspected or for more severe infections 1, 3
Treatment Duration and Approach
- Standard treatment duration for symptomatic UTIs in pregnancy is 5-7 days 1
- Shorter courses (1-3 days) are generally not recommended for pregnant women, except for fosfomycin which is effective as a single dose 1, 4
- Follow-up urine cultures should be performed 7 days after completing therapy to confirm cure 5
Medications to Avoid During Pregnancy
- Trimethoprim-sulfamethoxazole should be avoided in the first trimester (potential teratogenic effects) and third trimester (risk of neonatal hyperbilirubinemia) 1, 2
- Fluoroquinolones are contraindicated throughout pregnancy 1
Management of Recurrent UTIs in Pregnancy
- For pregnant women with history of recurrent UTIs, post-coital prophylaxis with a single dose of cephalexin (250 mg) or nitrofurantoin (50 mg) is highly effective 6
- Daily low-dose antibiotic prophylaxis can be considered for frequent recurrences 1
Special Considerations
- Pregnancy is classified as a complicating factor for UTIs, requiring more careful management 2
- Outpatient treatment is appropriate for uncomplicated UTIs, while more severe cases may require hospitalization and parenteral antibiotics 3, 7
- Even asymptomatic bacteriuria requires treatment during pregnancy, unlike in non-pregnant women 1
Common Pitfalls to Avoid
- Failing to obtain a urine culture before initiating treatment in pregnant women 1
- Using antibiotics that don't achieve adequate urinary concentrations 1
- Not following up with repeat urine cultures to confirm cure after treatment 5
- Using fluoroquinolones or trimethoprim-sulfamethoxazole inappropriately during pregnancy 1, 2