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Urinary tract infection (lower) - women - Management
How should I screen for and manage asymptomatic bacteriuria during pregnancy?
- Screen for asymptomatic bacteriuria on the first antenatal visit by sending urine for culture. If asymptomatic bacteriuria is found, send a second urine sample for culture.
- If the second urine culture confirms asymptomatic bacteriuria, treat for 7 days with an antibiotic to which the organism is sensitive.
- Preferred options when sensitivities are known are (in order of preference):
- Amoxicillin: 250 mg three times daily, for 7 days.
- Nitrofurantoin: 50 mg four times daily, or 100 mg (modified-release) twice daily, for 7 days.
- Trimethoprim: 200 mg twice daily, for 7 days (unless the woman is folate deficient or taking a folate antagonist).
- Cefalexin (500 mg twice daily, or 250 mg 6-hourly, for 7 days) may be used but is less preferred.
- After treatment, send urine for culture to screen for asymptomatic bacteriuria at every antenatal visit until delivery.
- If a group B streptococcus is isolated, inform the antenatal care service, as prophylactic antibiotics may be indicated during labour and delivery.
In depth
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