Treatment of UTI During Second Trimester of Pregnancy
For urinary tract infections during the second trimester of pregnancy, nitrofurantoin is recommended as the first-line antibiotic treatment, with fosfomycin as an acceptable alternative. 1
First-Line Treatment Options
- Nitrofurantoin is the preferred first-line antibiotic for UTIs during pregnancy, including the second trimester 1
- Fosfomycin is an acceptable alternative first-line agent when nitrofurantoin cannot be used 1
- Cephalosporins (such as cephalexin, cefpodoxime, or cefuroxime) are also appropriate options for treating UTIs during pregnancy 2
- The total course of therapy should be 7 to 14 days to ensure complete eradication of the infection 2
Antibiotics to Avoid During Pregnancy
- Fluoroquinolones (such as ciprofloxacin) should be avoided throughout all trimesters of pregnancy due to potential adverse effects 1, 3
- Trimethoprim-sulfamethoxazole should be avoided, particularly during the first trimester, due to potential teratogenic effects 1, 3
- Agents that do not achieve therapeutic concentrations in the bloodstream, such as nitrofurantoin, should not be used in cases of suspected pyelonephritis (kidney infection) 2
Diagnostic Approach
- All pregnant women with suspected UTI should have a urine culture performed before initiating antibiotic therapy 1, 4
- The presence of GBS bacteriuria in any concentration during pregnancy is a marker for heavy genital tract colonization and requires treatment 2
- Women with GBS bacteriuria during pregnancy should receive appropriate treatment at the time of diagnosis as well as intrapartum GBS prophylaxis during labor 2
Management Considerations
- Untreated UTIs in pregnancy can lead to serious complications including pyelonephritis, preterm labor, low birth weight, and sepsis 3, 4
- Delaying treatment in pregnant women with symptomatic UTI increases the risk of progression to pyelonephritis and adverse pregnancy outcomes 1, 4
- For severe infections or pyelonephritis, initial parenteral therapy may be required, with transition to oral therapy after clinical improvement 2, 4
- Preferred parenteral options for pyelonephritis include amoxicillin with an aminoglycoside, third-generation cephalosporins, or carbapenems 4
Follow-Up
- A follow-up urine culture should be performed 7 days after completing antibiotic therapy to confirm cure 5
- Recurrent UTIs during pregnancy may require prophylactic antibiotics, though evidence for specific regimens is limited 4
- Women with a history of UTIs should be monitored closely throughout pregnancy for recurrence 6, 4