UTI in Pregnancy - Antibiotic Prescribing

Comments from Expert Advisory Committee

• Send MSU for culture.
• Nitrofurantion- should be avoided after 36 weeks due to risk of neonatal haemolysis.
• Fosfomycin - Recommendation for use in pregnancy remains under review pending further evidence and safety data
• 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.

Treatment

*Seek specialist/microbiologist advice in case of penicillin allergy in pregnant patients

Patient Information

• Visit HSE My Child website for further information on urine infections in pregnancy. 
• Bumps – Best use of medicines in pregnancy (from UK Teratology Information Service) 
• Mother to Baby website (USA) for information on use of drugs in pregnancy and breast-feeding (Search or Use Browse by Medications category).
• 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 Jan 2021