gynecology and obstetrics
Urinary Tract Infection in Pregnancy
Treatment of UTI in Pregnancy
Antibacterial drugs such ascephalexin,nitrofurantoin, ortrimethoprim/sulfamethoxazole Proof-of-cure cultures and sometimes suppressive therapy Treatment of symptomatic UTI is not changed by pregnancy, except drugs that may harm the fetus are avoided (see table Some Drugs With Adverse Effects During Pregnancy ). Because asymptomatic bacteriuria may lead to pyelonephritis, it should be treated with antibiotics similar to an acute UTI. Antibacterial drug selection is based on individual and local susceptibility and resistance patterns, but good initial empiric choices include the following: Cephalexin Nitrofurantoin Trimethoprim/sulfamethoxazole Nitrofurantoinis contraindicated in pregnant patients at term, during labor and delivery, or when the onset of labor is imminent because hemolytic anemia in the neonate is possible. Pregnant women with G6PD (glucose-6-phosphate dehydrogenase) deficiency should not takenitrofurantoin. Incidence of neonatal jaundice is increased when pregnant women takenitrofurantoinduring the last 30 days of pregnancy.Nitrofurantoinshould be used during the 1st trimester only when no other alternatives are available. Trimethoprim/sulfamethoxazole(TMP/SMX) can cause congenital malformations (eg, neural tube defects) and kernicterus in the neonate.Folic acidsupplementation may decrease the risk of some congenital malformations. TMP/SMX should be used during the 1st trimester only when no other alternatives are available. After treatment, proof-of-cure cultures are required. Women who have pyelonephritis or have had more than one UTI may require suppressive therapy, usually with TMP/SMX (before 34 weeks) ornitrofurantoin, for the rest of the pregnancy. In women who have bacteriuria with or without UTI or pyelonephritis, urine should be cultured monthly. 