Beyond Expert Opinion: A Comparison of Antibiotic Regimens for Infectious Urinary Tract Pathology in Pregnancy

Abstract

Objective Outside pregnancy, nitrofurantoin, ciprofloxacin and sulfamethoxazole-trimethoprim (SMZ-TMP) are first-line therapy (FLT) for lower urinary tract infections (LUTIs). Optimal antibiotics for LUTI have been extrapolated based on expert opinion. Progression to pyelonephritis and adverse obstetric outcomes were compared between women who received FLT and those given alternative antibiotics. Methods This study includes a retrospective cohort of women with LUTI, including asymptomatic bacteriuria and acute cystitis at single health care system from July 2013 to May 2019. Women receiving FLT, defined as nitrofurantoin or SMZ-TMP, were compared with those receiving nonfirst-line therapy (nFLT). Primary outcome was progression to pyelonephritis. Secondary outcomes included pyelonephritis-related anemia, sepsis, length of stay, preterm birth (PTB), and low birth weight (LBW). Logistic regression was used to calculate odds of outcomes. Results Of 476 women, 336 (70.6%) received FLT and 140 (29.4%) received nFLT. Women receiving FLT were more likely having BMI ≥ 40 (p = 0.04). Progression to pyelonephritis did not differ (5.8 vs. 8.2%; p = 0.44), nor did other pyelonephritis-related outcomes. After controlling for confounders, no difference in odds of progression to pyelonephritis was seen (adjusted odds ratio [aOR] 1.02, 95% confidence interval [CI] 0.42, 2.49). FLT was not associated with PTB or LBW (aOR 0.60, 95% CI 0.29, 1.26) after controlling for confounders. Conclusion Receipt of antibiotics other than nitrofurantoin or SMZ-TMP for LUTI in pregnancy was not associated with increased risk of progression to pyelonephritis, PTB, or LBW.

Effects of S24–7 on the weight of progeny rats after exposure to ceftriaxone sodium during pregnancy

“…In recent years many diseases during pregnancy have been treated using antibiotics [12]; however, the risk of antibiotic exposure during pregnancy is gradually increasing [5]. Researchers have found that the growth of neonates is different from between those treated with and without antibiotics, and there is increasing, but controversial, evidence that exposure to antibiotics during pregnancy might have both short-and long-term effects on babies.…”

Which Antibiotic for Urinary Tract Infections in Pregnancy? A Literature Review of International Guidelines

“…Most infections are caused by Enterobacteriaceae , commonly found in the gastrointestinal tract, with Escherichia coli ( E. coli ) being responsible for 80–90% of cases. However, we can find other bacteria such as Group-B Streptococcus saprophyticus (GBSS), Klebsiella pneumoniae , coagulase-negative Staphylococcus , Staphylococcus aureus and Proteus mirabilis in a lower percentage [ 2 , 6 ].…”

“…In pregnant women, ASB occurs in an estimated 2–10% [ 7 ], and if left untreated, it can turn into symptomatic AC in 30% of patients and may progress to APN in up to 50% of those patients [ 6 ], which have been associated with several complications for both the mother and the unborn child [ 2 , 8 ].…”

Effects of S24-7 on the weight of progeny rats after exposure to ceftriaxone sodium during pregnancy

“…In recent years many diseases during pregnancy have been treated using antibiotics (Krischak et al, 2020); however, the risk of antibiotic exposure during pregnancy is gradually increasing (Dotters-Katz et al, 2020). Researchers have found that the growth of neonates is different from between those treated with and without antibiotics, and there is increasing, but controversial, evidence that exposure to antibiotics during pregnancy might have both short-and long-term effects on babies.…”