Treatments for symptomatic urinary tract infections during pregnancy

Urinary tract infections, including pyelonephritis, are serious complications that can result in significant maternal and neonatal morbidity and mortality. There is a large number of drugs, and combination of them, available to treat urinary tract infections, most of them tested in non-pregnant women. Attempts to define the optimal antibiotic regimen for pregnancy has, therefore, been problematic.

The objective of this review was to try to determine, from the best available evidence from randomized control trials, which agent is most effective for the treatment of symptomatic urinary tract infections during pregnancy in terms of cure rates, recurrent infection, incidence of preterm delivery and premature rupture of membranes, admission to neonatal intensive care unit, need for change of antibiotic, and incidence of prolonged pyrexia.

The Cochrane Pregnancy and Childbirth Group trials register (January 2003) and reference lists of articles were searched.

All trials were considered where the intention was to allocate participants randomly to one of at least two alternative treatments for any symptomatic urinary tract infection.

Both reviewers assessed trial quality and extracted data.

Eight studies were included, recruiting a total of 905 pregnant women. In most of the comparisons there were no significant differences between studied treatments with regard to cure rates, recurrent infection, incidence of preterm delivery and premature rupture of membranes, admission to neonatal intensive care unit, need for change of antibiotic and incidence of prolonged pyrexia. Only when cefuroxime and cephradine were compared, were there better cure rates (29/49 versus 41/52) and less recurrences (20/49 versus 11/52) in the cefuroxime group, but the sample size is insufficient to ensure that differences found in the effect of the drugs were real.

Although antibiotic treatment is effective for the cure of urinary tract infections, there are insufficient data to recommend any specific treatment regimen for symptomatic urinary tract infections during pregnancy. All the antibiotics studied were shown to be very effective in decreasing the incidence of outcomes measured. Complications were very rare. All included trials had very small sample sizes to try to detect important differences between treatments. Future studies should evaluate the most promising antibiotics, in terms of class, timing, dose, acceptability, maternal and neonatal outcomes and costs.