Editing Bacteruria in Pregnancy (section)

== Management ==

* '''Pregnant females with bacteruria should be prescribed a full 3-7 day course of therapy'''
** '''Pregnant females with acute pyelonephritis should be hospitalized and treated initially with parenteral antimicrobial agents.'''
* '''<span style="color:#ff0000">Agents considered safe (4):'''
** '''<span style="color:#ff0000">Penicillins'''
*** Ampicillin 500mg qid
*** Amoxicillin 250mg tid
*** Penicillin V 500mg qid
** '''<span style="color:#ff0000">Cephalosporins'''
*** Cephalexin 500mg qid
*** Cefaclor 500mg qid
** '''<span style="color:#ff0000">Fosfomycin'''[https://www.aafp.org/afp/2000/0201/p713.html §]
**'''<span style="color:#ff0000">Nitrofurantoin''' (if penicillin allergy) 100mg qid
*** '''<span style="color:#ff0000">Should be discontinued at 35 weeks (see above)'''
* '''<span style="color:#ff0000">Agents that should be avoided:'''
*# '''<span style="color:#ff0000">Fluoroquinolones: risk of damage to immature cartilage'''
*# '''<span style="color:#ff0000">Trimethroprim: risk of megaloblastic anemia because of anti-folic acid action'''
*# '''<span style="color:#ff0000">TMP/SMX: early, risk of teratogenicity; late, risk of kernicterus'''
*# '''<span style="color:#ff0000">Nitrofurantoin: avoid during 3rd trimester due to risk of hemolytic anemia'''
*# '''<span style="color:#ff0000">Chloramphenicol: risk of “gray baby” syndrome'''
*# '''<span style="color:#ff0000">Erythromycin: risk of maternal cholestatic jaundice'''
*# '''<span style="color:#ff0000">Tetracyclines: risk acute liver decompensation in the mother and inhibition of new bone growth in the fetus'''
* '''<span style="color:#ff0000">Follow-up cultures should be obtained to document absence of infection'''.
** If the culture is positive, the cause of bacteriuria must be determined to be lack of resolution, bacterial persistence, or reinfection.
*** If the infection is unresolved, proper selection and administration of another drug probably will solve the problem.
*** If the problem is bacterial persistence or rapid reinfection, antimicrobial suppression of infection or prophylaxis throughout the remainder of the pregnancy should be considered.
* '''If a pregnant female has a single episode of pyelonephritis or two episodes of cystitis, daily suppression with either nitrofurantoin or cephalexin should be considered until delivery.'''