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Urinary tract infection (lower) - women - Management
How should I manage a pregnant woman whose cystitis has failed to respond to antibiotics?

  • Check compliance with antibiotic treatment.
  • Continue symptomatic treatment with paracetamol.
  • Send a urine sample for culture.
  • If symptoms are troublesome, offer a different antibiotic (nitrofurantoin or trimethoprim) while waiting for the culture results — see Managing suspected acute cystitis during pregnancy.
  • If infection is confirmed on culture, treat with an antibiotic to which the organism is sensitive.
  • If infection is not confirmed on culture, consider other possible causes for the symptoms — see Differential diagnosis.
  • If cystitis symptoms fail to respond to a second antibiotic shown by urine culture results to be appropriate treatment, seek specialist advice.
Basis for recommendation

These recommendations are in line with guidance from the Scottish Intercollegiate Guidelines Network [SIGN, 2006].

  • The recommendation to offer a different antibiotic if symptoms persist is supported by a recent study of the course of uncomplicated community-acquired urinary tract infection in women [McNulty et al, 2006]. The study found that, after 5 days of antibiotic treatment, symptoms had resolved in 70% of women infected with an organism sensitive to the antibiotic, and 24% of women with a resistant isolate. The study also found that 50% of those who reconsulted in the first week had a resistant isolate.

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