Recurrent UTI (pregnant)
Recurrent UTIs in pregnancy: if three or more episodes of infection in pregnancy have been confirmed on culture and a recent culture has confirmed clearance.
Renal ultrasound and prophylactic antibiotics should be considered if three or more episodes of infection in pregnancy have been confirmed on culture and a recent culture has confirmed clearance.
Self-care
Adequate daily fluid intake (at least 1.6L/day) and perineal hygiene (such as voiding after sexual intercourse) may be of benefit in women with recurrent infection.
It is also useful to provide a clean specimen container to these women so that a timely specimen can be collected if symptoms develop.
Antibiotic prophylaxis
Consider the following:
- Previous culture results and susceptibility – if unsure speak to Micro/ID
- Previous antimicrobial treatment
- Gestational weeks
- Allergy and tolerance to antimicrobials
- Renal function
- Liver function
Speak to Micro/ID if culture result has resistance to the following antibiotics.
Empirical prophylactic antibiotic regimes include:
Preferred including non-severe penicillin allergy
cefalexin 250mg po at night
Alternative OR Severe penicillin allergy
For patients with penicillin allergy label consider penicillin allergy assessment and delabelling
trimethoprim 100 mg po at night (avoid 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 )
OR
Discuss with Micro/ID
Duration
Review antibiotic prophylaxis for recurrent UTI at least every 6 months and post pregnancy, with the review to include:
- Assessing the success of prophylaxis
- Discussion of continuing, stopping or changing prophylaxis (taking into account the person's preferences for antibiotic use and the risk of antimicrobial resistance)
- A reminder about behavioural and personal hygiene measures and self-care treatments
If antibiotic prophylaxis is stopped, ensure that people have rapid access to treatment if they have an acute UTI.
Additional information
NICE guidance for recurrent lower UTI associated with sexual intercourse in non-pregnant women suggests offering trimethoprim 100 mg to be taken within 2 hours of intercourse (off-label use). However, there is no evidence of benefit for this approach in pregnancy.