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Urinary tract infection (lower) - women - Management
How should I manage a pregnant woman with suspected acute cystitis?
- Convey a positive approach and reassure the woman that treatment with an antibiotic will prevent any harm to her baby, and will shorten the duration of symptoms.
- If the women has fever or loin tenderness, suspect upper urinary tract infection and admit or seek urgent specialist opinion.
- Offer paracetamol for symptomatic relief. Do not recommend urine alkalinizing agents or cranberry products. Do not recommend urine alkalinizing agents or cranberry products.
- Send a urine sample for culture before starting antibiotic treatment.
- Prescribe an antibiotic empirically. If local guidelines are not available, suitable first-line antibiotics are (in order of preference):
- Nitrofurantoin 50 mg four times daily, or 100 mg (modified-release) twice daily, for 7 days.
- Trimethoprim 200 mg twice daily, for 7 days (if the person is not folate deficient or taking a folate antagonist, and has not been treated with trimethoprim in the past year).
- Cefalexin 500 mg twice daily, or 250 mg 6-hourly, for 7 days.
- Follow up after 48 hours (or according to the clinical situation) to check response to treatment and the urine culture results.
- Amoxicillin 250 mg three times daily, for 7 days, is recommended only if the organism is reported to be susceptible on the culture results.
In depth
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