From the Guidelines
Nitrofurantoin is the recommended first-line treatment for urinary tract infections (UTIs) during pregnancy, with a dosage of 100mg twice daily for 5 days, as suggested by the European Association of Urology guidelines 1. When considering safe antibiotics for UTIs during pregnancy, several options are available.
- Nitrofurantoin macrocrystals are recommended at a dose of 50–100 mg four times a day for 5 days 1.
- Alternatively, nitrofurantoin monohydrate or macrocrystals can be prescribed at a dose of 100 mg twice daily for 5 days 1.
- Fosfomycin trometamol is also an option, with a single dose of 3 g for 1 day 1.
- Pivmecillinam can be used at a dose of 400 mg three times a day for 3–5 days 1. It's essential to note that trimethoprim should be avoided in the first trimester of pregnancy, and trimethoprim-sulfamethoxazole should not be used in the last trimester 1.
- Cephalosporins, such as cefadroxil, can be considered as alternative options, but their use depends on the local resistance pattern for Escherichia coli 1. Pregnant women should always consult with their healthcare provider before taking any medication, as they will consider the specific situation and local resistance patterns.
From the Research
Safe Antibiotics for UTI during Pregnancy
- The following antibiotics are considered safe for treating UTIs during pregnancy:
- Amoxicillin: Single-dose cure rates with amoxicillin are approximately 80 percent 2
- Trimethoprim/sulfamethoxazole: Provides cure rates of greater than 80 percent 2
- Nitrofurantoin: Recommended for asymptomatic bacteriuria and symptomatic UTI 2, 3
- Cephalosporins: Can be used as an alternative, but may produce variable results 2
- It is essential to note that the choice of antibiotic should be based on the susceptibility of the organism and the patient's medical history 2, 4
- 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 antibiotics with a favorable maternal and fetal safety profile 5
- However, there are areas of discordance among guidelines, such as the use of fluoroquinolones in lower or upper UTI 5
- It is crucial to follow the recommended treatment guidelines and to monitor the patient's response to therapy to ensure effective treatment and minimize the risk of complications 2, 4