Treatment Options for Uncomplicated UTIs in Pregnancy

First-Line Treatment Options

• The American College of Obstetricians and Gynecologists recommends nitrofurantoin monohydrate/macrocrystals 100 mg twice daily for 5 days as a first-line treatment option due to minimal resistance and low propensity for collateral damage 1
• The European Association of Urology suggests fosfomycin trometamol 3 g single dose as a convenient regimen for pregnant women with uncomplicated UTIs 2

Diagnostic Approach

• The American College of Obstetricians and Gynecologists recommends urine culture for pregnant women with suspected UTI 1
• The European Association of Urology advises screening for and treating asymptomatic bacteriuria (ASB) in pregnant women 2
• The European Association of Urology recommends treatment with standard short-course therapy or single-dose fosfomycin trometamol when ASB is detected in pregnancy 2

Important Caveats and Pitfalls

• The American College of Obstetricians and Gynecologists recommends avoiding fluoroquinolones during pregnancy due to potential risks to fetal development 1
• The American College of Obstetricians and Gynecologists advises against using trimethoprim in the first trimester of pregnancy due to potential teratogenic effects 1
• Local resistance patterns should guide empiric antibiotic selection, as recommended by the American College of Obstetricians and Gynecologists 1