Treatment of Urinary Tract Infections in Pregnancy
First-line treatment for urinary tract infections during pregnancy should be nitrofurantoin (100 mg twice daily for 5-7 days), fosfomycin trometamol (3g single dose), or cephalosporins, with treatment duration typically 5-7 days depending on the specific medication. 1
Recommended First-Line Antibiotics
- Nitrofurantoin (100 mg twice daily for 5 days) is effective but should be avoided in the third trimester due to risk of hemolytic anemia in the newborn 1
- Fosfomycin trometamol (3g single dose) offers convenient administration that improves compliance and is equally effective as multi-day regimens 1
- Cephalosporins (such as cefixime or cephalexin) are appropriate options, particularly when resistance to other agents is suspected 1, 2
- For oral therapy of uncomplicated UTIs, cefixime may be particularly rational due to high sensitivity of E. coli, effectiveness, safety, and good compliance in pregnant women 3
Diagnostic Approach
- A urine culture should always be performed in pregnant women with UTI symptoms before initiating treatment to confirm diagnosis and guide therapy 1, 2
- All pregnant women should be screened for asymptomatic bacteriuria, as it requires treatment to prevent progression to symptomatic infection 2, 4
- The presence of Group B streptococci bacteriuria in any concentration during pregnancy requires treatment and intrapartum prophylaxis during labor 2
Treatment Duration and Special Considerations
- Treatment duration should be 5-7 days for symptomatic UTIs in pregnancy, as shorter courses (1-3 days) are generally not recommended for complete eradication 1
- For severe infections or pyelonephritis, initial parenteral therapy may be required, with transition to oral therapy after clinical improvement 2
- Asymptomatic bacteriuria in pregnancy must be treated, as untreated cases can lead to pyelonephritis in up to 40% of cases with subsequent risks to both mother and fetus 5
- For women with recurrent UTIs during pregnancy, postcoital prophylaxis with a single dose of cephalexin (250 mg) or nitrofurantoin (50 mg) has been shown to be highly effective 6
Antibiotics to Avoid
- 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 due to potential adverse effects 1, 2
- Nitrofurantoin should not be used for suspected pyelonephritis as it doesn't achieve therapeutic concentrations in the bloodstream 2
Common Pitfalls to Avoid
- Delaying treatment in pregnant women with symptomatic UTI increases risk of pyelonephritis and adverse pregnancy outcomes 2
- Using unnecessarily long antibiotic courses, which can promote resistance 1
- Failing to obtain follow-up urine cultures 7 days after treatment to confirm cure 7
- Neglecting to treat asymptomatic bacteriuria, which can lead to serious maternal and fetal complications 4