Urinary Tract Infections in Pregnancy Medication
- Author: Emilie Katherine Johnson, MD, MPH; Chief Editor: Edward David Kim, MD, FACS more...
The goals of pharmacotherapy are to eradicate the infection, reduce morbidity, and prevent complications. Agents used include antibiotics and analgesics.
Nitrofurantoin is a synthetic nitrofuran that interferes with bacterial carbohydrate metabolism by inhibiting acetylcoenzyme A. It is bacteriostatic at low concentrations (5-10 mcg/mL) and bactericidal at higher concentrations. It is bactericidal against uropathogens such as Staphylococcus saprophyticus, Enterococcus faecalis, and Escherichia coli; it possesses no activity against Proteus, Serratia, or Pseudomonas species. It received a "B, I" rating in the 1999 IDSA guidelines for treating UTIs.
It is manufactured in different forms to facilitate durable urine concentrations: macrocrystals (Macrodantin), microcrystal suspension (Furadantin), and a combined preparation (Macrobid). This agent achieves no appreciable concentrations in the prostate, kidney, or blood. Administer 100 mg orally twice daily for 5-7 days.
This is a first-generation cephalosporin that inhibits bacterial growth by inhibiting bacterial cell wall synthesis. It is bactericidal and effective against rapidly growing organisms forming cell walls. Administer 500 mg orally twice daily for 3-7 days.
Amoxicillin interferes with the synthesis of cell wall mucopeptides during active multiplication, resulting in bactericidal activity against susceptible bacteria. This drug combination treats bacteria normally resistant to beta-lactam antibiotics. Administer 500/125 mg orally twice daily for 3-7 days.
Amoxicillin interferes with synthesis of cell wall mucopeptides during active multiplication, resulting in bactericidal activity against susceptible bacteria. Administer 500 mg orally twice daily for 5-7 days.
Cefuroxime is a second-generation cephalosporin that maintains the gram-positive activity of first-generation cephalosporins; it adds activity against Proteus mirabilis, Haemophilus influenzae, Escherichia coli, Klebsiella pneumoniae, and Moraxella catarrhalis. Administer 250 mg orally twice daily for 3-7 days
Fosfomycin was given a "B, I" rating in the 1999 IDSA guidelines for treating UTIs. Phosphonic acid is a bactericidal agent active against most UTI pathogens, including Escherichia coli and Enterobacter, Klebsiella, and Enterococcus species. Little cross-resistance between fosfomycin and other antibacterial agents exists. It is primarily excreted unchanged in the urine, and concentrations remain high for 24-48 hours after a single dose. It is unique but quite expensive. Administer 3 g orally as single dose with 3-4 oz of water
[Guideline] Nicolle LE, Bradley S, Colgan R, Rice JC, Schaeffer A, Hooton TM. Infectious Diseases Society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults. Clin Infect Dis. 2005 Mar 1. 40(5):643-54. [Medline].
Minassian C, Thomas SL, Williams DJ, Campbell O, Smeeth L. Acute maternal infection and risk of pre-eclampsia: a population-based case-control study. PLoS One. 2013 Sep 3. 8(9):e73047. [Medline]. [Full Text].
McKenzie H, Donnet ML, Howie PW, Patel NB, Benvie DT. Risk of preterm delivery in pregnant women with group B streptococcal urinary infections or urinary antibodies to group B streptococcal and E. coli antigens. Br J Obstet Gynaecol. 1994 Feb. 101(2):107-13. [Medline].
[Guideline] American Academy of Pediatrics and American College of Obstetricians and Gynecology. Guidelines for Perinatal Care. American Academy of Pediatrics. 2007. 6th ed:
Smaill F. Asymptomatic bacteriuria in pregnancy. Best Pract Res Clin Obstet Gynaecol. 2007 Jun. 21(3):439-50. [Medline].
Alvarez JR, Fechner AJ, Williams SF, Ganesh VL, Apuzzio JJ. Asymptomatic bacteriuria in pregestational diabetic pregnancies and the role of group B streptococcus. Am J Perinatol. 2010 Mar. 27(3):231-4. [Medline].
Hollowell JG. Outcome of pregnancy in women with a history of vesico-ureteric reflux. BJU Int. 2008 Sep. 102(7):780-4. [Medline].
Ghafari A, Sanadgol H. Pregnancy after renal transplantation: ten-year single-center experience. Transplant Proc. 2008 Jan-Feb. 40(1):251-2. [Medline].
Versi E, Chia P, Griffiths DJ, Harlow BL. Bacteriuria in pregnancy: a comparison of Bangladeshi and Caucasian women. Int Urogynecol J Pelvic Floor Dysfunct. 1997. 8(1):8-12. [Medline].
Mazor-Dray E, Levy A, Schlaeffer F, Sheiner E. Maternal urinary tract infection: is it independently associated with adverse pregnancy outcome?. J Matern Fetal Neonatal Med. 2009 Feb. 22(2):124-8. [Medline].
Sheiner E, Mazor-Drey E, Levy A. Asymptomatic bacteriuria during pregnancy. J Matern Fetal Neonatal Med. 2009 May. 22(5):423-7. [Medline].
Whitehead NS, Callaghan W, Johnson C, Williams L. Racial, ethnic, and economic disparities in the prevalence of pregnancy complications. Matern Child Health J. 2009 Mar. 13(2):198-205. [Medline].
Hill JB, Sheffield JS, McIntire DD, Wendel GD Jr. Acute pyelonephritis in pregnancy. Obstet Gynecol. 2005 Jan. 105(1):18-23. [Medline].
Collier CH, Risnes K, Norwitz ER, Bracken MB, Illuzzi JL. Maternal infection in pregnancy and risk of asthma in offspring. Matern Child Health J. 2013 Dec. 17(10):1940-50. [Medline].
Easter SR, Cantonwine DE, Zera CA, Lim KH, Parry SI, McElrath TF. Urinary tract infection during pregnancy, angiogenic factor profiles, and risk of preeclampsia. Am J Obstet Gynecol. 2016 Mar. 214 (3):387.e1-7. [Medline].
[Guideline] U.S. Preventive Services Task Force. Screening for asymptomatic bacteriuria in adults: U.S. Preventive Services Task Force reaffirmation recommendation statement. Ann Intern Med. 2008 Jul 1. 149(1):43-7. [Medline].
Duarte G, Marcolin AC, Quintana SM, Cavalli RC. [Urinary tract infection in pregnancy]. Rev Bras Ginecol Obstet. 2008 Feb. 30(2):93-100. [Medline].
Millar LK, Cox SM. Urinary tract infections complicating pregnancy. Infect Dis Clin North Am. 1997 Mar. 11(1):13-26. [Medline].
Kodikara H, Seneviratne H, Kaluarachchi A, Corea E. Diagnostic accuracy of nitrite dipstick testing for the detection of bacteriuria of pregnancy. Public Health. 2009 May. 123(5):393-4. [Medline].
Gilstrap LC 3rd, Ramin SM. Urinary tract infections during pregnancy. Obstet Gynecol Clin North Am. 2001 Sep. 28(3):581-91. [Medline].
Widmer M, Gülmezoglu AM, Mignini L, Roganti A. Duration of treatment for asymptomatic bacteriuria during pregnancy. Cochrane Database Syst Rev. 2011. (12):CD000491. [Medline].
Mathai E, Thomas RJ, Chandy S, Mathai M, Bergstrom S. Antimicrobials for the treatment of urinary tract infection in pregnancy: practices in southern India. Pharmacoepidemiol Drug Saf. 2004 Sep. 13(9):645-52. [Medline].
Millar LK, Wing DA, Paul RH, Grimes DA. Outpatient treatment of pyelonephritis in pregnancy: a randomized controlled trial. Obstet Gynecol. 1995 Oct. 86(4 Pt 1):560-4. [Medline].
FDA Drug Safety Communication: FDA advises restricting fluoroquinolone antibiotic use for certain uncomplicated infections; warns about disabling side effects that can occur together. U.S. Food and Drug Administration. Available at http://www.fda.gov/drugs/drugsafety/ucm500143.htm. May 12, 2016; Accessed: July 21, 2016.
Vazquez JC, Abalos E. Treatments for symptomatic urinary tract infections during pregnancy. Cochrane Database Syst Rev. 2011 Jan 19. CD002256. [Medline].
Widmer M, Gülmezoglu AM, Mignini L, Roganti A. Duration of treatment for asymptomatic bacteriuria during pregnancy. Cochrane Database Syst Rev. 2011 Dec 7. 12:CD000491. [Medline].
Bozkurt Y, Penbegul N, Soylemez H, Atar M, Sancaktutar AA, Yildirim K, et al. The efficacy and safety of ureteroscopy for ureteral calculi in pregnancy: our experience in 32 patients. Urol Res. 2012 Jan 4. [Medline].
Lichtenberger P, Hooton TM. Antimicrobial prophylaxis in women with recurrent urinary tract infections. Int J Antimicrob Agents. 2011 Dec. 38 Suppl:36-41. [Medline].
ACOG. ACOG educational bulletin. Antibiotics and gynecologic infections. American College of Obstetricians and Gynecologists. Number 237, June 1997 (Replaces No. 153, March 1991). Int J Gynaecol Obstet. 1997 Sep. 58(3):333-40. [Medline].
Rouse DJ, Andrews WW, Goldenberg RL, Owen J. Screening and treatment of asymptomatic bacteriuria of pregnancy to prevent pyelonephritis: a cost-effectiveness and cost-benefit analysis. Obstet Gynecol. 1995 Jul. 86(1):119-23. [Medline].
Thurman AR, Steed LL, Hulsey T, Soper DE. Bacteriuria in pregnant women with sickle cell trait. Am J Obstet Gynecol. 2006 May. 194(5):1366-70. [Medline].
Kazemier BM, Schneeberger C, De Miranda E, Van Wassenaer A, Bossuyt PM, Vogelvang TE. Costs and effects of screening and treating low risk women with a singleton pregnancy for asymptomatic bacteriuria, the ASB study. BMC Pregnancy Childbirth. 2012. 12:52. [Medline].
Wing DA, Rumney PJ, Preslicka CW, Chung JH. Daily cranberry juice for the prevention of asymptomatic bacteriuria in pregnancy: a randomized, controlled pilot study. J Urol. 2008 Oct. 180(4):1367-72. [Medline]. [Full Text].
Uehling DT, Hopkins WJ, Elkahwaji JE, Schmidt DM, Leverson GE. Phase 2 clinical trial of a vaginal mucosal vaccine for urinary tract infections. J Urol. 2003 Sep. 170(3):867-9. [Medline].
Mann JR, McDermott S. Are Maternal Genitourinary Infection and Pre-Eclampsia Associated With ADHD in School Aged Children?. J Atten Disord. 2010 Sep 13. [Medline].
Sun Y, Vestergaard M, Christensen J, Nahmias AJ, Olsen J. Prenatal exposure to maternal infections and epilepsy in childhood: a population-based cohort study. Pediatrics. 2008 May. 121(5):e1100-7. [Medline].