UTI Treatment in Pregnancy

Drugs to use ✔️ Vs Drugs to avoid ✖️

It’s crucial to navigate UTI treatment in pregnant patients with utmost care. Here’s a concise guide:

✔️ For asymptomatic bacteriuria and cystitis:

• Nitrofurantoin (100 mg PO BID for 5-7 days) is safe in the second trimester.

• Alternatives include Amoxicillin (500 mg PO TID).

 Amoxicillin-Clavulanate (625 mg PO TID or 1g PO BID).

Cephalexin (500 mg PO QID). 

Fosfomycin (3 g orally as a single dose).

✔️ Recurrent cystitis:

• Consider nightly cephalexin (250 – 500 mg).

✔️ Pyelonephritis treatment:

• Hospital admission with IV antibiotics until afebrile for 48 hours.

Options include:

Ceftriaxone (1-2 g IV daily),

Cefepime (0.5-1 g IV every 12 hours).

Piperacillin-tazobactam (3.375 g IV every 6 hours). 

Meropenem (1 g IV every 8 hours).

Ertapenem (1 g IV every 24 hours) for 7-14 days.

💡Antibiotic selection should be based on urine culture sensitivities, if known. Often, therapy must be initiated on an empirical basis, before culture results are available.

Dose and therapy duration depend on the nature and severity of the infection.

⚠️ Drugs to avoid during pregnancy:

• Tetracyclines (impact fetal teeth and bones).

• Fluoroquinolones (toxic to developing cartilage).

• Trimethoprim-sulfamethoxazole is a safe medication to treat UTIs during the second trimester. (Trimethoprim is a folic acid antagonist and has been associated with an increased risk of birth defects when taken in the first trimester during organogenesis).

• Aminoglycosides (risk of ototoxicity).

• Nitrofurantoin near delivery (can cause hemolytic anemia) and in the first trimester (can cause cardiac defects ).

By staying updated on evidence-based guidelines, we ensure maternal infection resolution and fetal safety. Collaborating closely with healthcare providers is key.

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