Treatment of Urinary Tract Infections in Pregnant Women
For pregnant women with urinary tract infections, first-line treatment options include cephalosporins, nitrofurantoin, or fosfomycin, with a treatment duration of 7-14 days to ensure complete eradication of the infection. 1
Diagnostic Considerations
- All pregnant women should be screened for bacteriuria with urine culture, as asymptomatic bacteriuria must be treated in every case due to the high risk of progression to pyelonephritis 2, 3
- The presence of Group B Streptococcus (GBS) bacteriuria in any concentration during pregnancy requires treatment and subsequent intrapartum GBS prophylaxis during labor 1
- Urine culture should be obtained before initiating treatment to guide antibiotic selection 1, 4
First-Line Treatment Options
Lower UTI/Cystitis
- Nitrofurantoin 100 mg twice daily for 7 days (avoid in suspected pyelonephritis and near term) 1, 4
- Fosfomycin trometamol 3 g single dose 1, 4
- Cephalexin 500 mg four times daily for 7-14 days 1
- Cefpodoxime or cefuroxime for 7-14 days 1
Pyelonephritis
- Initial parenteral therapy is recommended for severe infections or pyelonephritis 1
- Appropriate options include:
Medications to Avoid During Pregnancy
- Trimethoprim and trimethoprim-sulfamethoxazole should be avoided during the first trimester due to potential teratogenic effects 1, 5
- Trimethoprim-sulfamethoxazole should also be avoided in the last trimester 4
- Fluoroquinolones should be avoided throughout pregnancy due to potential adverse effects on fetal development 1, 4
Follow-up and Monitoring
- Urine cultures should be repeated 7 days following therapy to assess cure or failure 6
- Pregnant women with recurrent UTIs may require closer monitoring and different management strategies 3
Special Considerations
- Asymptomatic bacteriuria in pregnancy must be treated to prevent complications, unlike in non-pregnant women 2, 3
- Delaying treatment in pregnant women with symptomatic UTI increases the risk of pyelonephritis and adverse pregnancy outcomes 1
- Antibiotic choice should be guided by local resistance patterns and patient-specific factors such as allergies 1, 4
Potential Complications if Untreated
- Increased risk of pyelonephritis 2, 3
- Potential for preterm delivery and low birth weight 7, 3
- Maternal complications including sepsis 3
Treatment Duration
- For lower UTIs: 7-14 days of therapy is recommended 1
- For pyelonephritis: 14 days of total therapy (initial parenteral followed by oral) 1, 4
UTIs during pregnancy require prompt diagnosis and appropriate antibiotic therapy to prevent complications for both mother and fetus. The choice of antibiotic should balance efficacy against potential risks to the developing fetus.