Urinary Tract Infections in Pregnancy
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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)
ManagementTreatment
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
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
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