From the Guidelines
Pregnant women with asymptomatic bacteriuria should be screened for and treated with standard short-course treatment or single-dose fosfomycin trometamol to prevent complications such as pyelonephritis, preterm labor, and low birth weight. According to the most recent guidelines from the European Association of Urology 1, screening for and treating asymptomatic bacteriuria in pregnant women is recommended. This is supported by older studies, such as the Infectious Diseases Society of America guidelines 1, which reported that antimicrobial treatment of asymptomatic bacteriuria during pregnancy decreases the risk of subsequent pyelonephritis and improves outcomes for both mother and baby.
Some key points to consider when treating UTIs in pregnancy include:
- Using antibiotics that are safe during pregnancy, such as nitrofurantoin, amoxicillin-clavulanate, or cephalexin
- Avoiding trimethoprim-sulfamethoxazole in the first and third trimesters
- Providing a urine sample for culture before starting antibiotics and having a follow-up test after completing treatment
- Encouraging increased fluid intake, urinating before and after intercourse, and wiping from front to back to help prevent recurrence
It's essential to prioritize the treatment of asymptomatic bacteriuria in pregnant women due to the increased risk of complications, such as pyelonephritis, preterm labor, and low birth weight 1. The physiological changes of pregnancy, including urinary stasis and mechanical compression by the enlarging uterus, make pregnant women more susceptible to UTIs. Therefore, prompt treatment with appropriate antibiotics is crucial to prevent these complications and ensure the best possible outcomes for both mother and baby.
From the Research
UTI in Pregnancy: Overview
- Urinary tract infections (UTI) in pregnant women are a relatively frequent occurrence, with a spectrum of infections ranging from lower urinary tract disease to upper urinary tract disease 2.
- Anatomical and functional changes in the urinary tract during pregnancy result in a higher susceptibility to progression of the infection from asymptomatic bacteriuria to acute pyelonephritis 2.
Risks and Complications
- Untreated asymptomatic bacteriuria in pregnancy can lead to the development of acute pyelonephritis, resulting in negative effects for both the woman and the fetus 2.
- Bacteriuria in pregnancy is associated with a higher number of newborns with low birth weight, low gestational age, and higher neonatal mortality rate 2.
Treatment and Management
- The selection of an appropriate antimicrobial agent to treat urinary tract infection in pregnancy is limited by the safety of the drug for both the woman and the fetus 2.
- International guidelines recommend specific antibiotics for the treatment of UTI during pregnancy, taking into account maternal and fetal safety profiles 3.
- The choice of antibiotic should be based on the results of urine culture and local susceptibility patterns 2, 3.
Antibiotic Options
- Nitrofurantoin, trimethoprim-sulfamethoxazole, and sulfonamides are commonly used antibiotics for the treatment of uncomplicated lower urinary tract infections 4, 5.
- Fluoroquinolones, cephalosporins, and beta-lactams are also used as second-line options or for more complicated infections 4.
- New antimicrobials, such as finafloxacin and sitafloxacin, are being developed for the treatment of UTIs caused by multidrug-resistant organisms 4.
Guidelines and Recommendations
- International guidelines agree on several key points regarding antibiotic use for UTI treatment during pregnancy, including the importance of antenatal screening for bacteriuria and the selection of appropriate antibiotics 3.
- The guidelines also recommend careful consideration of the maternal and fetal safety profiles of antibiotics when selecting treatment options 3.