UTI, lower, non-severe (pregnant)
UTI lower, non-severe (pregnant) symptomatic
Urinary tract infection (UTI) is diagnosed when there are lower urinary symptoms (dysuria, urgency and frequency) AND positive urinalysis.
Do not delay starting antibiotic treatment in pregnant women who are symptomatic by waiting for culture results. Treatment may be changed according to sensitivity test results.
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
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
Reference
- NICE NG109 Urinary Tract Infection (lower): antimicrobial prescribing October 2018. Available: Overview | Urinary tract infection (lower): antimicrobial prescribing | Guidance | NICE