Antibiotic prophylaxis to prevent recurrent UTI and bacteriuria in pregnancy

Consider antibiotic prophylaxis for pregnant patients with recurrent UTI or recurrent bacteriuria (2 or more episodes during pregnancy)Bonkat, 2024The American College of Obstetricians and Gynaecologists (ACOG), 2023. For patients with additional risk factors for pyelonephritis (eg immune compromise, suboptimally managed diabetes, neurogenic bladder) who had asymptomatic bacteriuria, seek expert advice regarding antibiotic prophylaxisBonkat, 2024.

Options for antibiotic prophylaxis for recurrent UTI or bacteriuria in pregnancy are intermittent postcoital prophylaxis (for pregnant patients in whom episodes of recurrent UTI are triggered by sexual intercourse) or continuous prophylaxisBonkat, 2024The American College of Obstetricians and Gynaecologists (ACOG), 2023. When prescribing for pregnant patients, consider the safety of the antimicrobial in the individual patient.

For intermittent postcoital prophylaxis of UTI and bacteriuria in pregnancy, useBonkat, 2024The American College of Obstetricians and Gynaecologists (ACOG), 2023:

1nitrofurantoin 50 mg orally as a single dose, taken within 2 hours after sexual intercourse; maximum of one dose daily1. For dosage adjustment in adults with kidney impairment, see nitrofurantoin dosage adjustment nitrofurantoin nitrofurantoin nitrofurantoin

OR

2cefalexin 250 mg orally as a single dose, taken within 2 hours after sexual intercourse; maximum of one dose daily. For dosage adjustment in adults with kidney impairment, see cefalexin dosage adjustment. cefalexin cefalexin cefalexin

For continuous prophylaxis of UTI and bacteriuria in pregnancy, use:

1cefalexin 250 mg orally, at night for the remainder of the pregnancy. For dosage adjustment in adults with kidney impairment, see cefalexin dosage adjustment cefalexin cefalexin cefalexin

OR

2nitrofurantoin 50 mg orally, at night until 37 weeks gestation1. For dosage adjustment in adults with kidney impairment, see nitrofurantoin dosage adjustment. nitrofurantoin nitrofurantoin nitrofurantoin

If UTI recurs despite continuous antibiotic prophylaxis, seek expert advice.

1 Avoid using nitrofurantoin close to delivery (after 37 weeks gestation, or sooner if early delivery is planned) because of the possible increased risk of neonatal jaundice and haemolytic anaemia.Return