URINARY TRACT INFECTIONS IN PREGNANCY

Urinary tract infections are common in pregnancy, and maybe associated with adverse consequences.

Clinical features

Uncomplicated cystitis

  • Low abdominal pain
  • Frequency and urgency of micturition
  • Dysuria (pain at micturition)

Pyelonephritis

  • Fever
  • Renal angle tenderness
  • Vomiting, tachycardia

Investigations

  • Urine dipstick (for nitrate and/or leucocytes, also protein and blood may be present)
  • Full blood count (raised in pyelonephritis)

MANAGEMENT

For cystitis

  • Encourage increased oral fluid intake
  • Nitrofurantoin 100 mg twice a day for 5 days (avoid in 1st trimester and at term)
  • Or Amoxicillin 500 mg every 8 hours for 5 days

For pyelonephritis

  • Admit and hydrate
  • Ceftriaxone 1 g IV daily for 48 hours or until fever subsides, then switch to
  • Cefixime 200 mg every 12 hours for 10 days

If ceftriaxone not available

  • Ampicillin 500 mg IV every 6 hours + gentamicin 5-7 mg/kg in 2-3 divided doses IM
    (max 80 mg/dose) for 10-14 days