Lower UTI in Pregnancy

Comments from Expert Advisory Committee

• Send MSU for culture.
• Nitrofurantion- should be avoided after 36 weeks due to risk of neonatal haemolysis.
• Refer to local resistance patterns for empiric therapy where available and refer to MSU results. Amoxicillin resistance is common – only use if susceptibility data available.
• Review empirical treatment with results of MSU culture and susceptibility.
• Note guidelines on Asymptomatic Bacteriuria in Pregnancy
• If acute pyelonephritis is suspected, consider referral to hospital. Consider acute pyelonephritis/ upper UTI when:
  • Pain in the loin which radiates to the iliac fossa and suprapubic area.
  • Sudden onset general systemic disturbance with fever, rigors, vomiting.
  • Tenderness and guarding over the kidney.

Treatment

*Seek specialist/microbiologist advice in case of penicillin allergy in pregnant patients if nitrofurantoin is not an option.

Patient Information

• Visit HSE A-Z website for further information on urine urinary tract infections in pregnancy. 
• Bumps – Best use of medicines in pregnancy (from UK Teratology Information Service)
• Visit HPSC Information Leaflets pages for the General Public, (MRSA, CRE, etc)

Safe Prescribing (visit the safe prescribing page)

• Doses are oral and for adults unless otherwise stated
• Dosing in children quick reference dosage/weight guide
• Penicillin allergy – tips on prescribing in penicillin allergy
• Renal impairment dosing table
• Drug interactions table. Extensive drug interactions for clarithromycin, fluoroquinolones, azole antifungals and rifampicin. Many antibiotics increase the risk of bleeding with anticoagulants.
• Visit the Health Products Regulatory Authority (HPRA) website for detailed drug information (summary of product characteristics and patient information leaflets). Dosing details, contraindications and drug interactions can also be found in the Irish Medicines Formulary (IMF) or other reference sources such as British National Formulary (BNF) / BNF for children (BNFC).

Reviewed November 2021