Bacteriuria, asymptomatic (pregnant)
If in doubt about choice of agent due to allergy, drug interactions, resistant organisms or contraindications, then the case should be discussed with ID/Micro
Treat for 5 days. For selected or complex patient, e.g abnormal urinary tract, ureteric stent, renal calculi, reflux nephropathy, urinary diversion, may extend to 7 days.
For pregnant women with solid organ transplant see UTI: out-patient setting (Transplant)
Preferred - Empirical
nitrofurantoin 50mg po qds. AVOID after 37+0 weeks of gestation or if delivery is thought to be imminent due to potential risk of neonatal haemolysis.
Caution: Do not use if eGFR is under 45 ml/min/1.73m2
Adverse effects have been reported with nitrofurantoin see Nitrofurantoin MHRA drug safety updates
Alternative - Empirical
cefalexin 500mg po bd
Treatment according to culture and sensitivity in the following order of preference
amoxicillin 500mg po tds
If resistant to amoxicillin: nitrofurantoin 50mg po qds. AVOID after 37+0 weeks of gestation or if delivery is thought to be imminent due to potential risk of neonatal haemolysis. Caution: Do not use if eGFR is under 45 ml/min/1.73m2 . Adverse effects have been reported with nitrofurantoin see Nitrofurantoin MHRA drug safety updates
If resistant to nitrofurantoin: cefalexin 500mg po bd
If resistant to cefalexin: trimethoprim 200mg po bd (avoid in first trimester1)
Additional information
1. Avoid trimethoprim if possible in the 1st trimester due to the risk of neural tube defects in the fetus; if given, supplement with folic acid 5 mg OD.