Urinary Tract Infection (UTI) in Pregnancy

 


 

Summary of
Consensus Guidelines on Management of Urinary Tract Infection in Pregnancy 2021 (MOH)

1. What are some definitions of UTI?

  • Lower urinary tract infection - LUTI
    • include acute cystitis, acute urethritis 
  •  asymptomatic bacteriuria (ASB)
    • UTI without symptoms
  • acute pyelonephritis 
    • infection of the kidneys
    • results from untreated LUTI


2. What are the signs and symptoms of UTI in pregnancy?

  • dysuria - painful urination
  • cloudy urine
  • hematuria
  • abdominal pain
  • urgency - unable to hold urine
  • increased frequency of urination
  • in acute pyelonephritis
    • flank / renal angle pain
    • pyuria
    • fever / systemic illness

3. How to assess someone with possible urinary tract infection in pregnancy?

  • no need to screen those without symptoms
  • those with symptoms, can use reagent strip test
    • nitrite +ve : treat with antibiotic
    • nitrite -ve, leucocyte -ve : unlikely UTI
    • nitrite -ve, leucocyte +ve 
      • if symptoms suggestive of UTI, treat with antibiotic


4. How to treat UTI in pregnancy

  • for ASB or UTI with symptoms, treat with one of the following antibiotics for 5-7 days 
    • nitrofurantoin 50-100mg QID (avoid in 3rd trimester)
    • cephalexin 500mg QID
    • trimethoprom / sulphmethoxazole 160/8000mg BD
    • cefuroxime 250mg BD
  • for acute pyelonephritis
    • require admission to hospital
    • treat with one of the following IV antibiotics, usually for 10-14 days 
      • Amoxicillin 1.2g TDS
      • Cefuroxime 750mg TDS
      • Ampicillin / sulbactam 1.5-3g TDS (Unasyn)
    • further workup
      • urine culture 

      • blood culture

  • take a follow up urine culture 1-2 weeks after completion of treatment, then another one in 3rd trimester


5. What are non pharmacological management of UTI in pregnancy

  • good hygiene
    • wash the genital area after sex
    • void the bladder after sex
    • wipe the genital area after voiding from front to back direction (not back to front)
  • drink a lot of water
  • cranberry juice
  • ascorbic acid 100mg OD
    • can recommend for those high risk 

    

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