Treatment of Recurrent UTIs in Pregnancy
Diagnostic Criteria for Recurrent UTIs
- Recurrent UTIs are defined as ≥3 UTIs per year or ≥2 UTIs in the last 6 months 2
- Confirmation requires documented positive urine cultures during symptomatic episodes 1
- Avoid surveillance urine testing in asymptomatic patients 3
Acute Treatment of UTI During Pregnancy
- First-line antibiotics for symptomatic UTIs in pregnancy include nitrofurantoin 50-100 mg daily (avoid in third trimester) 1, 2
- Fosfomycin 3g single dose is a first-line antibiotic option 2
- TMP-SMX 160/800 mg (avoid in first and third trimesters) is a first-line antibiotic option 1, 2
- Treatment duration should be as short as reasonable, generally 3-7 days 1
Prevention of Recurrent UTIs in Pregnancy
- Continuous daily prophylaxis options include nitrofurantoin 50-100 mg daily 2
- TMP-SMX 40/200 mg daily (avoid in first and third trimesters) is a continuous daily prophylaxis option 2
- Cephalexin 250 mg daily is a continuous daily prophylaxis option 2
Special Considerations for Pregnancy
- Asymptomatic bacteriuria should be treated in pregnant women, unlike non-pregnant populations 3
- Avoid TMP-SMX in first trimester (risk of neural tube defects) and third trimester (risk of neonatal hyperbilirubinemia) 2
- Avoid nitrofurantoin in late third trimester due to risk of hemolytic anemia in G6PD-deficient neonates 2
Monitoring and Follow-up
- Do not perform routine post-treatment cultures in asymptomatic patients 2
Non-antibiotic Approaches
- Increased fluid intake is recommended (weak recommendation but minimal risk) 2
- Consider cranberry products as adjunctive therapy (weak recommendation) 2
- Behavioral modifications: voiding after intercourse, adequate hydration, avoiding prolonged holding of urine 4