Urinary Tract Infections in Pregnancy

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ICD10 CODE: O23

Urinary tract infections are common in pregnancy, and maybe associated with adverse consequences.

Clinical features

Uncomplicated cystitis

• Low abdominal pain
• Frequency and urgency of micturition
• Dysuria (pain at micturition)

Pyelonephritis

• Fever
• Renal angle tenderness
• Vomiting, tachycardia

Investigations

• Urine dipstick (for nitrate and/or leucocytes, also protein and blood may be present)
• Full blood count (raised in pyelonephritis)

Management

Treatment	LOC
For cystitis Encourage increased oral fluid intake Nitrofurantoin 100 mg twice a day for 5 days (avoid in 1st trimester and at term) Or Amoxicillin 500 mg every 8 hours for 5 days	HC2
For pyelonephritis Admit and hydrate Ceftriaxone 1 g IV daily for 48 hours or until fever subsides, then switch to Cefixime 200 mg every 12 hours for 10 days	HC4 H
If ceftriaxone not available Ampicillin 500 mg IV every 6 hours + gentamicin 5-7 mg/kg in 2-3 divided doses IM (max 80 mg/dose) for 10-14 days	HC3