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Urinary Tract Infections in Pregnancy Medication

  • Author: Emilie Katherine Johnson, MD, MPH; Chief Editor: Edward David Kim, MD, FACS  more...
 
Updated: Jul 21, 2016
 

Medication Summary

The goals of pharmacotherapy are to eradicate the infection, reduce morbidity, and prevent complications. Agents used include antibiotics and analgesics.

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Antibiotics

Nitrofurantoin (Furadantin, Macrobid, Macrodantin)

 

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.

Cephalexin (Keflex)

 

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 and clavulanate (Augmentin, Amoclan)

 

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 (Moxatag)

 

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 (Ceftin, Zinacef)

 

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 (Monurol)

 

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

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Contributor Information and Disclosures
Author

Emilie Katherine Johnson, MD, MPH Head of Clinical Research, Attending Physician, Division of Urology, Ann and Robert H Lurie Children’s Hospital of Chicago; Assistant Professor of Urology, Assistant Professor, Center for Healthcare Studies, Institute for Public Health and Medicine Northwestern University, The Feinberg School of Medicine

Emilie Katherine Johnson, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Urological Association, National Medical Association, Society of Women in Urology

Disclosure: Nothing to disclose.

Chief Editor

Edward David Kim, MD, FACS Professor of Surgery, Division of Urology, University of Tennessee Graduate School of Medicine; Consulting Staff, University of Tennessee Medical Center

Edward David Kim, MD, FACS is a member of the following medical societies: American College of Surgeons, Tennessee Medical Association, Sexual Medicine Society of North America, American Society for Reproductive Medicine, American Society of Andrology, American Urological Association

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Repros.

Additional Contributors

J Stuart Wolf, Jr, MD, FACS David A Bloom Professor of Urology, Associate Chair for Urologic Surgical Services, Director, Division of Endourology and Stone Disease, Department of Urology, University of Michigan Medical School

J Stuart Wolf, Jr, MD, FACS is a member of the following medical societies: Catholic Medical Association, Endourological Society, Engineering and Urology Society, Society of Laparoendoscopic Surgeons, Society of University Urologists, Society of Urologic Oncology, American College of Surgeons, American Urological Association

Disclosure: Nothing to disclose.

Acknowledgements

Gamal Mostafa Ghoniem, MD, FACS Professor of Urology, Chief, Division of Female Urology, Pelvic Reconstructive Surgery, and Voiding Dysfunction, Department of Urology, University of California, Irvine, School of Medicine

Gamal Mostafa Ghoniem, MD, FACS is a member of the following medical societies: American College of Surgeons, American Urogynecologic Society, American Urological Association, International Continence Society, International Urogynaecology Association, and Society of Urodynamics and Female Urology

Disclosure: Astellas Honoraria Speaking and teaching; Coloplasty Consulting fee Board membership; Uroplasty Consulting fee Consulting

Leticia A Jones, MD Clinical Instructor, Department of Obstetrics and Gynecology, Indiana University Hospital, Clarian Health Partners

Leticia A Jones, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists

Disclosure: Nothing to disclose.

Mark Jeffrey Noble, MD Consulting Staff, Urologic Institute, Cleveland Clinic Foundation

Mark Jeffrey Noble, MD is a member of the following medical societies: American College of Surgeons, American Medical Association, American Urological Association, Kansas Medical Society, Sigma Xi, Society of University Urologists, and Southwest Oncology Group

Disclosure: Nothing to disclose.

Henry E Ruiz, MD Chief, Reconstructive Urology and Urodynamics, Urology Associates of South Texas, PA and Radiation Oncology Center

Henry E Ruiz, MD is a member of the following medical societies: American Urological Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Patrick J Woodman, DO, Assistant Director, Urogynecology (FPMRS) Fellowship, Associate Clinical Professor, Indiana University School of Medicine; Consulting Staff, Department of Obstetrics and Gynecology, Methodist Hospital

Patrick J Woodman, DO is a member of the following medical societies: American College of Obstetricians and Gynecologists; American College of Surgeons; American Osteopathic Association; American Urogynecologic Society; Association of Professors of Gynecology and Obstetrics; Indiana State Medical Association; International Continence Society

Disclosure: Nothing to disclose.

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Twenty-nine-year-old pregnant woman with history of reflux uropathy and ureteral reimplantation at age 21 months presents with right-side flank pain and proteinuria. Renal cortical thinning suggests chronic hydronephrosis.
Color-flow Doppler highlights normal flow in right kidney of 29-year-old pregnant woman with history of reflux uropathy and ureteral reimplantation at age 21 months who presents with right-side flank pain and proteinuria.
25-year-old pregnant woman with right lower quadrant pain and hematuria has proximal ureteral obstruction consistent with urolithiasis. After 25 minutes, intravenous pyelography reveals dense right nephrogram and no filling of right collecting system. Left side shows unremarkable nonhydronephrotic collecting system. This is consistent with right ureteral lithiasis.
Table. Treatment Regimens for Pregnant Women with UTI
First-line therapy
  • Nitrofurantoin monohydrate/macrocrystals 100 mg orally twice daily for 5-7 days or
  • Amoxicillin 500 mg orally twice daily (alternative: 250 mg orally three times daily) for 5-7 days or
  • Amoxicillin-clavulanate 500/125 mg orally twice daily for 3-7 days (alternative: 250/125 mg orally three times daily for 5-7 days) or
  • Cephalexin 500 mg orally twice daily for 3-7 days
Second-line therapy
  • Fosfomycin 3 g orally as single dose with 3-4 oz. of water
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