💊 Management

  • Send urine MCS (microscopy, culture and sensitivity).
  • 1st line: Nitrofurantoin 100 mg BD for 7 days
    • Avoid at term (risk of neonatal haemolysis)
    • Only if eGFR > 45
  • 2nd line options:
    • Amoxicillin 500 mg TDS for 7 days
    • Cefalexin 500 mg BD for 7 days
  • Trimethoprim is contraindicated (folate antagonist and teratogenic risk)

Follow-up

  • Repeat urine culture should be performed after completion of antibiotics to ensure clearance (test of cure) as per NICE.
  • If group B streptococcal bacteriuria is identified on culture - inform midwife/obstetric team
    • intrapartum intravenous antibiotic prophylaxis should be offered in labour (e.g. IV BenPen)

📝 Exam Clues & Clinchers

  • Pregnant woman with UTI → send MCS and give 7-day course 
    • Nitrofurantoin 100mg BD 1st line
  • Avoid nitrofurantoin at term, or if eGFR < 45
  • Trimethoprim contraindicated in pregnancy
  • Always repeat culture after treatment

🔗 Useful Links and References