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

Abstract

Urinary tract infection (UTI) is considered to be a major problem in pregnant women. It is also one of the most prevalent infections during pregnancy, being diagnosed in as many as 50–60% of all gestations. Therefore, UTI treatment during pregnancy is extremely important and management guidelines have been published worldwide to assist physicians in selecting the right antibiotic for each patient, taking into account the maternal and fetal safety profile. A review of the literature was carried out and all international guidelines giving recommendations about antibiotic treatments for pregnancy-related UTI were selected. The search came back with 13 guidelines from 4 different continents (8 from Europe, 3 from South America, 1 from North America and 1 from Oceania). Our review demonstrated concordance between guidelines with regard to several aspects in the antibiotic treatment of UTI during pregnancy and in the follow-up after treatment. Nonetheless, there are some areas of discordance, as in the case of antenatal screening for bacteriuria and the use of fluoroquinolones in lower or upper UTI. Given the current evidence that we have from international guidelines, they all agree on several key points about antibiotic use.

Prevalence of urinary tract infections in pregnant women and antimicrobial resistance patterns in women in Riyadh, Saudi Arabia: a retrospective study

“…According to our findings, nitrofurantoin and amoxicillin-clavulanic acid should be recommended for use as an empirical therapy for UTIs in pregnant and nonpregnant women because bacteria have the least amount of resistance to these drugs, considering that nitrofurantoin should be avoided in the 3rd trimester of pregnancy [ 21 ]. On the other hand, bacteria had the greatest resistance to ampicillin, trimethoprim-sulfamethoxazole, and ciprofloxacin.…”

Comparative Analysis of Microbial Species and Multidrug Resistance Patterns Associated with Lower Urinary Tract Infections in Preterm and Full-Term Births

“…Interestingly, antimicrobial resistance for E. coli was lower in other studies, compared with our findings of 10.7% ESBL organisms, while GBS showed higher sensitivity to common antibiotics [ 32 , 33 ]. Regarding antibiotic use, most studies favor nitrofurantoin as the first-line treatment for UTIs in pregnant women, except for specific conditions and late pregnancy [ 34 ]. High organism sensitivity to penicillins, erythromycin, and cephalosporins is noted in the literature, with moderate sensitivity to cefuroxime, commonly used in empirical therapy for culture-negative cases, comparable to an overall resistance percentage of 12.1% for second-generation cephalosporines in our study, although it was significantly higher among mothers who gave birth preterm [ 35 ].…”

Real world drug treatment models for pregnancy complicated with urinary tract infection in China from 2018 to 2022: a cross-section analysis

“…Current research is more concerned with the etiology, bacterial spectrum, and drug sensitivity of urinary tract infections in expectant women ( Belete, 2020 ; Belete and Saravanan, 2020 ; Getaneh et al, 2021 ; Ali et al, 2022 ). The guidelines for drug treatment regimens and follow-up after mode treatment for UTI in pregnancy are consistent, but there are still inconsistencies, such as prenatal screening for bacteriuria and the use of fluoroquinolones in lower or upper urinary tract infections ( Corrales et al, 2022 ). A study of 1,140 pregnant women with ASB revealed that it is impossible to determine which drug is the most effective or safe for treating UTIs during pregnancy ( Guinto et al, 2010 ).…”