eMedicine Specialties > Urology > Infections and Related Inflammatory Conditions

Urinary Tract Infections in Pregnancy: Treatment & Medication

Author: Leticia A Jones, MD, Clinical Instructor, Department of Obstetrics and Gynecology, Indiana University Hospital, Clarian Health Partners
Coauthor(s): 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; Henry E Ruiz, MD, Chief, Reconstructive Urology and Urodynamics, Urology Associates of South Texas, PA and Radiation Oncology Center
Contributor Information and Disclosures

Updated: Oct 9, 2008

Treatment

Medical Care

Any discussion of treatment should be prefaced with a discussion of behavioral methods to ensure good hygiene and to reduce bacterial contamination of the urethral meatus. This is important in preventing inadequate treatment and recurrent infection. These behavioral methods include avoiding baths, wiping front-to-back after urinating or defecating, washing hands before using the toilet, using washcloths to clean the perineum, using liquid soap to prevent colonization from bar soap, and cleaning the urethral meatus first when bathing.

  • Ensure, through diagnosis and treatment, that a more serious process is not the cause of the symptoms.
  • Oral antibiotics are the treatment of choice for asymptomatic bacteriuria (ASB) and cystitis.
    • Although antibiotic courses of 1, 3, and 7 days have been evaluated, 10-14 days of treatment is usually recommended to eradicate the offending bacteria. Data are insufficient to abandon these more traditional long-term regimens using evidence-based medicine.
    • Treatment success depends on eradication of the bacteria rather than the duration of therapy. A test-for-cure urine culture should show negative findings 1-2 weeks posttherapy. A non-negative culture result is an indication for switching antibiotics, followed by suppressive therapy until 6 weeks postpartum.
    • Mathai and Thomas et al suggest the need for disseminated guidelines for practitioners in developing countries such as India.6 In their study, they found that the use of antibiotics was inappropriate in terms of safety, cost, susceptibility, and threat for developing resistance.
  • The standard course of treatment for pyelonephritis is admission with intravenous antibiotics. Administer IV fluids with caution. Patients with pyelonephritis can become dehydrated because of nausea and vomiting and need intravenous hydration. However, patients are at high risk for development of pulmonary edema and adult respiratory distress syndrome (ARDS).
  • Manage fever with antipyretics (eg, acetaminophen). Manage nausea and vomiting with antiemetics.
  • Preterm labor and delivery are additional risks associated with pyelonephritis, and they need to be evaluated and treated early in the course of admission.

Surgical Care

  • Surgical care is rarely indicated, unless one of the pathologic causes listed in the differential diagnoses is suspected (see Differentials).
  • In patients with urethral or bladder diverticulum, bladder stones, urethral syndrome, lower urinary tract trauma, interstitial cystitis, or bladder cancer, cystoscopy may help in establishing the diagnosis.
  • A retrograde stent or a percutaneous nephrostomy tube should be used to relieve ureteral colic and/or to decompress an obstructed infected collecting system. More invasive procedures, such as ureteroscopic stone extraction, are rarely indicated.
  • In the rare patient in whom invasive surgical therapy is indicated, timing should be planned for the second trimester. Surgical intervention during the first trimester is associated with miscarriage; in the third trimester, surgery is associated with preterm labor. Urgent surgical intervention in the third trimester should coincide with delivery of the fetus.
  • Extracorporeal shock wave lithotripsy (ESWL) is contraindicated in pregnancy.

Consultations

  • Early after admission, consult an obstetrician or a physician familiar with the care of pyelonephritis in pregnancy. Preterm labor and delivery are additional risks associated with pyelonephritis and need to be evaluated and treated early in the course of admission.
  • Consult a urologist if an obstructing urolithiasis or an infected collecting system is suspected.
  • Coexisting medical disorders that warrant consultation when found in conjunction with pyelonephritis include the following:
    • Preexisting diabetes
    • Gestational diabetes
    • Cardiac disease
    • Autoimmune disease
    • Renal disease

Diet

Diet is as tolerated. If the patient cannot tolerate oral intake, she can be maintained on nothing-by-mouth (NPO) status until she is able to tolerate oral intake. The only caveat is that the patient should remain NPO if surgical intervention is being considered.

Activity

  • For outpatient treatment, activity is not altered.
  • Patients admitted for pyelonephritis should limit activity based on the severity of symptoms.
  • Patients who may lose consciousness upon ambulation place themselves and the fetus at significant risk.
  • If the patient has no other reason for limitation of activity, routine activity as an inpatient is acceptable.

Medication

Some antibiotics should not be used during pregnancy because of their effects on the fetus. These include tetracyclines (adverse effects on fetal teeth and bones, congenital defects), quinolones (various congenital defects), trimethoprim in the first trimester (facial defects, cardiac abnormalities), and chloramphenicol and sulfonamides in the last trimester (Gray syndrome; hemolytic anemia in mothers with glucose-6-phosphate dehydrogenase [G-6-PD] deficiency, jaundice, and kernicterus, respectively).

Nitrofurantoin (Macrodantin) is a safe and effective drug. In the past, it was avoided in the third trimester because of hemolytic effects on the newborn; however, Macrodantin has subsequently been limited to use only in women during labor and delivery because of the possibility of hemolytic anemia in the fetus or the newborn infant due to their immature erythrocyte enzyme systems (glutathione instability). Macrodantin has also been shown to be safe used as a once-daily prophylactic therapy.

Patients with acute pyelonephritis should be systemically treated with cephalosporins or gentamicin. Asymptomatic patients do not need long courses of antibiotics but still should undergo a regimen of at least 7-10 days. Appropriate oral regimens include cephalexin 500 mg qid, ampicillin 500 mg qid, nitrofurantoin 100 mg bid, or sulfisoxazole 1 g qid. Studies with cephalexin, co-trimoxazole, and amoxicillin have indicated that a single dose is as effective as a 3- to 7-day course of therapy, but the cure rate is only 70%. Women in whom bacteriuria persists or in whom symptoms develop should be treated with a 10- to 14-day course of a different antibiotic. Then, prophylactic antibiotics (ie, nitrofurantoin 50 mg qhs) should be administered for the rest of the pregnancy.

Antibiotic therapy should be based on urine culture sensitivities, if known. Often, therapy is initiated prior to culture-result availability. This requires clinical knowledge of the most common organisms (ie, E coli) and their practice-specific and/or hospital-specific sensitivities to medications. Several methods of treatment for asymptomatic bacteriuria (ASB) have been studied and are available, including single-day regimens (ASB), short-course (ie, 3 d), and the more traditional 7- to 10-day regimens (uncomplicated cystitis). Pyelonephritis or complicated urinary tract infections (UTIs) (ie, recurrent or persistent UTIs) should be treated with 10-14 days of therapy. Patients with pyelonephritis, recurrent UTIs, concurrent stone disease, or indwelling ureteral stents should receive prophylactic antibiotics throughout pregnancy and should undergo frequent urine testing.

Institution-specific drug resistances should also be considered before a treatment antibiotic is chosen. For instance, with E coli infection alone, resistance to ampicillin can be as high as 28-39%. Resistance to trimethoprim-sulfamethoxazole has been described as 31% and, to first-generation cephalosporins, as high as 9-19%.

Maternal physiologic changes that influence pharmacokinetics include increased glomerular filtration rate and renal plasma flow, increased volume of distribution, decreased gastric motility and emptying, and decreased albumin levels. Serum levels of antibiotics are lower in pregnancy because of the gross increase in blood volume and increased glomerular filtration rate.

Fluoroquinolones are contraindicated in pregnancy. Although in utero exposure is not an indication for termination, fetal exposure to fluoroquinolones has resulted in myelomeningocele, hydrocephaly, hypospadias, maldescended testes, inguinal hernia, bilateral hip dysplasia, and atrial septal defects. The anomalies do not seem to follow a particular pattern, which may be reassuring. However, a causal relationship cannot be excluded.

Penicillins

These are bactericidal agents that are excreted in the urine. The resistance of E coli to ampicillin and amoxicillin is 20-40%; therefore, they are no longer considered an optimal choice for treatment of UTI.


Amoxicillin (Amoxil, Polymox)

A semisynthetic antibiotic, an analog of ampicillin, with a broad spectrum of bactericidal activity against many gram-positive and gram-negative microorganisms. Caps contain 250 mg or 500 mg of amoxicillin as a trihydrate. Tabs contain 500 mg or 875 mg of amoxicillin as a trihydrate. Stable in gastric acid and absorbed rapidly after oral dosing. Diffuses readily into most body tissues and fluids except the brain and spinal fluid. Diffusion into the brain and spinal fluid occurs in the presence of inflammation of the meninges. Peak blood levels occur 1-2 h after administration.

Adult

1-Day regimen: 3 g PO bid
3-Day regimen: 500 mg PO qid
7-Day regimen: 250 mg PO q8h

Pediatric

Not established

Probenecid decreases renal tubular secretion of amoxicillin and may result in increased and prolonged blood levels; reduces the efficacy of oral contraceptives

Documented hypersensitivity; known resistance to more common pathogens for UTIs

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Success with the 1-d regimen is lower than with the 3-d and 7-d regimens; probenecid decreases the renal tubular secretion of amoxicillin and may result in increased and prolonged blood levels; high urine concentrations of ampicillin may result in false-positive reactions when testing for the presence of glucose in the urine using Clinitest, Benedict solution, or Fehling solution; these effects also may occur with amoxicillin


Amoxicillin/clavulanate potassium (Augmentin)

Clavulanic acid is active against plasmid-mediated beta-lactamases responsible for transferred drug resistance to penicillins and cephalosporins. May be administered in the fed or fasting state, although clavulanic acid is better absorbed in the fed state. Better coverage against E coli, both beta-lactamase and non–beta-lactamase producing.

Adult

500 mg PO tid for 7-10 d

Pediatric

Not established

Coadministration with warfarin or heparin increases the risk of bleeding

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Administer for a minimum of 10 d to eliminate organism and to prevent sequelae (ie, endocarditis, rheumatic fever); following treatment, obtain cultures to confirm eradication of streptococci; because 250-mg tabs have the same dose of clavulanic acid as 500-mg tabs, administering 2 (250-mg) tabs is not recommended to achieve a 500-mg dose


Ampicillin (Principen, Omnipen)

A semisynthetic penicillin derived from the basic penicillin nucleus. Bactericidal at low concentrations. Clinically effective against gram-positive organisms sensitive to penicillin G, as well as various gram-negative organisms. Stable in the presence of gastric acid and is well-absorbed from the GI tract. Diffuses readily into most body tissues and fluids, except the brain and spinal fluid. Diffusion into the brain and spinal fluid occurs in the presence of inflammation of the meninges. Excreted, largely unchanged, in the urine. Excretion can be delayed by concurrent administration of probenecid, which inhibits renal tubular secretion of ampicillin. The least protein-bound of all the penicillins in blood serum (20%) compared with other penicillins (60-90%). Blood serum levels are attained within 1-2 h after oral administration in the fasting state.

Adult

500 mg PO qid for 3 d or for 7 d
2 g IV q6h for treatment of pyelonephritis; use in conjunction with an aminoglycoside for treatment of pyelonephritis

Pediatric

Not established

Probenecid and disulfiram elevate ampicillin levels; allopurinol decreases ampicillin effects and has additive effects on ampicillin rash; may decrease effects of oral contraceptives

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

High urine concentrations of ampicillin may result in false-positive reactions when testing for the presence of glucose in the urine using Clinitest, Benedict solution, or Fehling solution


Ampicillin sodium/sulbactam sodium (Unasyn)

An injectable antibiotic with a beta-lactamase inhibitor in sulbactam. Both ampicillin and sulbactam are excreted in the urine.

Adult

3 g IV q6h for treatment of pyelonephritis

Pediatric

Not established

Probenecid and disulfiram elevate ampicillin levels; allopurinol decreases ampicillin effects and has additive effects on ampicillin rash; may decrease effects of oral contraceptives

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

High urine concentrations of ampicillin may result in false-positive reactions when testing for presence of glucose in the urine using Clinitest, Benedict solution, or Fehling solution; adjust dose in renal failure; evaluate rash and differentiate from hypersensitivity reaction

Cephalosporins (beta-lactams)

These are categorized into first-, second-, and third-generation. Second- and third-generation medications have a greater spectrum of coverage. Cephalosporins are excreted in the urine. These medications are bactericidal, inhibiting cell wall synthesis.


Cephalexin hydrochloride (Keftab, Keflex)

First-generation cephalosporin that arrests bacterial growth by inhibiting bacterial cell wall synthesis. Bactericidal activity against rapidly growing organisms. Primary activity is against skin flora. Used for skin infections or prophylaxis in minor procedures.

Adult

500 mg PO qid

Pediatric

Not established

High urine concentrations of Keftab may result in false-positive reactions when testing for presence of glucose in urine using Clinitest, Benedict solution, or Fehling solution; aminoglycosides increase nephrotoxic potential of cephalexin

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

A positive direct Coombs test result has been reported with use of cephalosporins; adjust dose in renal impairment


Ceftriaxone (Rocephin)

Third-generation cephalosporin with broad-spectrum gram-negative activity, lower efficacy against gram-positive organisms, and higher efficacy against resistant organisms. Arrests bacterial growth by binding to one or more penicillin-binding proteins. IM dosing reaches maximum plasma levels 2-3 h after dosing. High concentrations are found in the urine. Sixty-seven percent is excreted in the urine as unchanged drug. Ceftriaxone is also excreted through the biliary tract. Patients with renal failure usually do not require a dosage change. Its use is in the treatment of pyelonephritis. Dosing is once a day. Once-a-day dosing with ceftriaxone has been compared to cefazolin 2 g tid for inpatient management of pyelonephritis in pregnancy and is as effective. IV therapy was terminated based on classic criteria, and patients were discharged on oral medications.
Millar and colleagues (1995) used ceftriaxone in the outpatient management of pyelonephritis in pregnancy. Clinicians should be aware that this is not standard therapy in pregnancy and that this method of therapy requires the ability to obtain close follow-up with skilled home health care providers.

Adult

1 g IV/IM qd

Pediatric

Not established

Probenecid may increase ceftriaxone levels; coadministration with ethacrynic acid, furosemide, and aminoglycosides may increase nephrotoxicity

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

A positive direct Coombs test result has been reported with the use of cephalosporins; alterations in the prothrombin time occur rarely; adjust dose in renal impairment; caution in breastfeeding women and those with allergy to penicillin

Aminoglycosides

Derived from Micromonospora purpurea (an actinomycete), aminoglycosides can accumulate in the sera of patients with impaired renal function. The more severe the impairment, the more the dosage must be adjusted. Aminoglycosides have varying degrees of nephrotoxicity and ototoxicity. Aminoglycosides are effective treatments against Pseudomonas, Proteus, Klebsiella, Enterobacter, Serratia species, and E coli. Aminoglycosides are not indicated in the uncomplicated initial episodes of UTIs unless the organism is resistant to less toxic antibiotics. Aminoglycosides have a synergistic effect with penicillins. Aminoglycosides cross the placenta, and reports exist of streptomycin causing bilateral congenital deafness in children whose mothers received the medication during pregnancy; however, gentamicin is indicated in the treatment of neonatal sepsis.


Gentamicin (Garamycin)

Produced in a sodium-bisulfite form that may cause an allergic-type reaction in susceptible patients. Excreted renally. No reports linking the use of gentamicin to congenital defects have been located. Ototoxicity due to exposure in utero is not reported.

Adult

3 mg/kg/d IV in 3 equal doses q8h; duration of treatment is based on clinical response and should be discontinued and oral agents begun after the patient becomes asymptomatic

Pediatric

Not established

Increased risk of nephrotoxicity reported following concomitant use with cephalosporins; avoid use with other neurotoxic medications; potential of magnesium-sulfate (MgSO4)-induced neuromuscular weakness has been reported in a neonate exposed to magnesium before delivery and then to gentamicin for treatment of sepsis

Documented hypersensitivity; non–dialysis-dependent renal insufficiency

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Aminoglycosides should be used with caution in patients with neuromuscular disease (eg, myasthenia gravis) because these drugs may aggravate muscular weakness; all patients should be well-hydrated during treatment; peak and trough levels are recommended; peak levels occur between 30 min and 1 h after IV dose and should be <12 mcg/mL; trough levels should be <2 mcg/mL and should be drawn before the next dose; serum concentrations may be lower than in afebrile patients administered the same dose; febrile and anemic states may decrease the serum half-life of the medication; dosage adjustment is not necessary and serum levels may rise with the patient becoming afebrile


Vancomycin (Lyphocin, Vancocin, Vancoled)

Potent antibiotic directed against gram-positive organisms and active against Enterococcus species. Useful in the treatment of septicemia. Indicated for patients who cannot receive, or who have failed to respond to, penicillins and cephalosporins or for patients who have infections with resistant staphylococci. To avoid toxicity, the current recommendation is to assay vancomycin trough levels after the third dose drawn 0.5 h prior to next dosing. Use creatinine clearance to adjust dose in patients diagnosed with renal impairment.
Used in conjunction with gentamicin for prophylaxis in penicillin-allergic patients undergoing gastrointestinal or genitourinary procedures.

Adult

500 mg/d to 2 g/d IV divided tid/qid for 7-10 d

Pediatric

40 mg/kg/d IV divided tid/qid for 7-10 d

Erythema, histaminelike flushing, and anaphylactic reactions may occur when administered with anesthetic agents; when taken concurrently with aminoglycosides, the risk of nephrotoxicity may increase above that with aminoglycoside monotherapy; effects in neuromuscular blockade may be enhanced when coadministered with nondepolarizing muscle relaxants

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Caution in renal failure and neutropenia; red man syndrome is caused by too rapid IV infusion (dose administered over a few min) but rarely happens when dose is administered as a 2-h administration or as PO or IP administration; red man syndrome is not an allergic reaction

Nitrofurans

These agents interfere with bacterial carbohydrate metabolism by inhibiting acetylcoenzyme A.


Nitrofurantoin (Macrobid, Furadantin)

Bactericidal in urine at therapeutic doses. Reactive intermediates inactivate or alter bacterial ribosomal proteins and other macromolecules; this inactivates vital cellular biochemical processes of protein synthesis, aerobic energy metabolism, DNA synthesis, RNA synthesis, and cell wall synthesis. Development of resistance to nitrofurantoin has not been a problem since its introduction. Taking with food enhances absorption and medication tolerance.
Macrobid contains 25 mg of nitrofurantoin macrocrystals and 75 mg of nitrofurantoin monohydrate. Nitrofurantoin is highly soluble in urine.

Adult

Macrobid: 1 tab PO bid for 3-5 d (25/75 mg); Harris and colleagues (1982) treated 22 pregnant patients with 200 mg of nitrofurantoin for a single dose and had a 68% success rate in the treatment of ASB; Macrobid 1 tab PO qhs is commonly used in prophylaxis after treatment for pyelonephritis; this is continued for the duration of gestation

Pediatric

Not established

Anticholinergics may delay gastric emptying and increase absorption, increasing nitrofurantoin bioavailability; antacids made of magnesium salts may decrease effects of nitrofurantoin by decreasing absorption; high doses of probenecid concurrently with nitrofurantoin decreases renal clearance and increases nitrofurantoin toxicity

Documented hypersensitivity; anuria, oliguria, or significant impairment of renal function; CrCl <60 mL/min; known G-6-PD deficiency in the RBC (found in 10% of blacks and a smaller percentage of Mediterranean people and people from the Near East)

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

High urine concentrations of nitrofurantoin may result in false-positive reactions when testing for presence of glucose in urine using Clinitest, Benedict solution, or Fehling solution; may cause severe and irreversible peripheral neuropathy that can be fatal; renal impairment, diabetes, electrolyte imbalance, anemia, and vitamin B deficiency increase risk for adverse effects; prolonged use of antibiotics may result in fungal or bacterial overgrowth of resistant or nonsusceptible organisms

Sulfonamide derivatives

These agents inhibit bacterial growth by inhibiting synthesis of dihydrofolic acid. Although their bioavailabilities vary, all share similar actions in the fetal period. As such, they should be considered as a single group.


Trimethoprim and sulfamethoxazole (Septra, Bactrim, Cotrim, Sulfatrim, Gantris)

Forty percent of trimethoprim and 70% of sulfamethoxazole are protein-bound. Renally excreted. Each tab of DS contains 160 mg of trimethoprim to 800 mg of sulfamethoxazole. Single strength has 80/400 mg (trimethoprim/sulfamethoxazole). Sulfamethoxazole inhibits metabolism of dihydrofolic acid by competing with para -aminobenzoic acid, and trimethoprim blocks the production of tetrahydrofolic acid from dihydrofolic acid, 2 important steps in the conversion of nucleic acids and proteins essential to many bacteria. Readily crosses the placenta.

Adult

1 DS tab PO bid for 3-5 d (160/800 mg)
Bailey and colleagues (1983) evaluated single-dose therapy for ASB in pregnancy, a dose of 2 tabs PO for 1 d (160/800 mg) yielded an 88% cure rate
160/800 mg IV q12h for the treatment of pyelonephritis

Pediatric

Not established

May increase PT when used with warfarin (perform coagulation tests and adjust dose accordingly); coadministration with dapsone may increase blood levels of both drugs; coadministration of diuretics increases incidence of thrombocytopenia purpura in elderly people; phenytoin levels may increase with coadministration; may potentiate effects of methotrexate in bone marrow depression; hypoglycemic response to sulfonylureas may increase with coadministration; may increase levels of zidovudine

Documented hypersensitivity; megaloblastic anemia; hemolysis may occur in patients who are G-6-PD deficient; Septra should be administered with caution to patients with folate deficiency or patients receiving anticonvulsant therapy

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Treatment near the time of delivery may result in increased bilirubin levels in the newborn and predispose newborns to kernicterus, jaundice, and hemolytic anemia; sulfonamides compete with bilirubin for binding to plasma proteins; unbound bilirubin is free to cross the blood-brain barrier and may result in kernicterus; in patients with HIV disease, an increased incidence of hyperkalemia and hyponatremia exists; reports of increased amino transaminase activity in patients with HIV exist

Macrolides

Macrolides are not first-line agents but are well-tolerated by mother and fetus.


Erythromycin (E.E.S., Eryc, Ery-Tab)

No published reports have linked the use of erythromycin with congenital defects. The drug crosses the placenta readily, but in concentrations too low to treat infections with most fetal pathogens.
Reduction in rates of pregnancy loss and low birth weight infants seen in patients treated with erythromycin during pregnancy.

Adult

250-500 mg PO qid for 3-5 d; used during third trimester to reduce maternal and infant colonization with group B beta-hemolytic streptococcus; also used to treat genital mycoplasmas

Pediatric

Not established

Inhibits CYP450 1A2, 3A3/4 isoenzymes; coadministration may increase toxicity of theophylline, digoxin, carbamazepine, and cyclosporine; may potentiate anticoagulant effects of warfarin; coadministration with lovastatin and simvastatin, increases risk of rhabdomyolysis; decreases metabolism of repaglinide, thus increasing serum levels and effects

Documented hypersensitivity; hepatic impairment

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Caution in liver disease; estolate formulation may cause cholestatic jaundice; GI side effects are common (give doses pc); discontinue use if nausea, vomiting, malaise, abdominal colic, or fever occurs

Phosphonic acid derivatives

These agents are useful in the treatment of uncomplicated UTIs caused by susceptible strains of E coli and Enterococcus species.


Fosfomycin (Monurol)

Synthetic broad-spectrum bacterial phosphonic acid antibiotic, given as a single 3-g oral dose of the trometamol salt for the treatment of uncomplicated cystitis in women. Following absorption, fosfomycin tromethamine is rapidly converted to the free acid fosfomycin.
Numerous clinical reports have studied fosfomycin during pregnancy without harm to fetus or newborn. It has been studied in all trimesters of pregnancy.

Adult

3 g PO in 4 oz of water as single dose

Pediatric

Not established

Food and antacids decrease absorption

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Adverse effects include diarrhea, vaginitis, and nausea

More on Urinary Tract Infections in Pregnancy

Overview: Urinary Tract Infections in Pregnancy
Differential Diagnoses & Workup: Urinary Tract Infections in Pregnancy
Treatment & Medication: Urinary Tract Infections in Pregnancy
Follow-up: Urinary Tract Infections in Pregnancy
Multimedia: Urinary Tract Infections in Pregnancy
References
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Further Reading

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Keywords

urinary tract infection, UTI, upper urinary tract infection, lower urinary tract infection, upper UTI, lower UTI, asymptomatic bacteriuria, ASB, bacteriuria, cystitis, urethritis, pyelonephritis, Escherichia coli, E coli, urinary stasis, ureterovesical reflux, vesicoureteral reflux, pyuria, acute cystitis, upper urinary tract disease, acute pyelonephritis, group B Streptococcus, GBS, Klebsiella pneumoniae, K pneumoniae, Proteus mirabilis, P mirabilis, Enterobacter species, Staphylococcus saprophyticus, S saprophyticus, group B beta-hemolytic Streptococcus, group B beta-hemolytic streptococci

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Contributor Information and Disclosures

Author

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.

Coauthor(s)

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, and International Continence Society
Disclosure: Glaxo-Smith-Klein Beechum Honoraria Speaking and teaching

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.

Medical Editor

Gamal Mostafa Ghoniem, MD, FACS, Fellowship Program Director, Clinical Professor of Surgery, Head, Section of Voiding Dysfunction, Female Urology and Reconstruction, Cleveland Clinic Florida
Gamal Mostafa Ghoniem, MD, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Society for Urology and Engineering, and Society of University Urologists
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

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.

CME Editor

J Stuart Wolf, Jr, MD, FACS, David A Bloom Professor of Urology, Director, Division of Minimally Invasive Urology, Department of Urology, University of Michigan Medical Center
J Stuart Wolf, Jr, MD, FACS is a member of the following medical societies: American College of Surgeons, American Medical Association, American Urological Association, Catholic Medical Association, Endourological Society, Society for Urology and Engineering, Society of Laparoendoscopic Surgeons, and Society of University Urologists
Disclosure: Terumo Corporation Consulting fee Consulting; Omeros Corporation Consulting fee Consulting

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, American Society for Reproductive Medicine, American Society of Andrology, American Urological Association, and Tennessee Medical Association
Disclosure: Lilly Consulting fee Consulting

 
 
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