Antibiotics for asymptomatic bacteriuria in pregnancy

Area of Science:

• Obstetrics and Gynecology
• Infectious Diseases
• Perinatal Medicine

Background:

• Asymptomatic bacteriuria (ASB) affects 2-15% of pregnancies and can lead to acute pyelonephritis.
• Untreated ASB is linked to adverse pregnancy outcomes like low birthweight and preterm birth.
• This review is an update of previous findings on ASB treatment in pregnancy.

Purpose of the Study:

• To evaluate the impact of antibiotic treatment for ASB on pyelonephritis development.
• To assess the effect of ASB treatment on risks of low birthweight and preterm birth.
• To update evidence on ASB management in pregnant women.

Main Methods:

• Conducted a systematic review of randomized controlled trials (RCTs) and quasi-RCTs.
• Searched multiple databases including Cochrane Pregnancy and Childbirth's Trials Register and ClinicalTrials.gov.
• Included 15 studies with over 2000 women, assessing risk of bias and evidence quality using GRADE.

Main Results:

• Antibiotic treatment may reduce pyelonephritis incidence (low-certainty evidence).
• A potential reduction in preterm birth and low birthweight was observed (low-certainty evidence).
• Evidence for serious adverse neonatal outcomes was inconclusive; maternal side effects were rarely reported.

Conclusions:

• Antibiotic treatment may effectively reduce pyelonephritis risk in pregnancy, though evidence certainty is low.
• Potential benefits for preterm birth and low birthweight exist, but require confirmation due to low-certainty evidence.
• Further research is needed to identify cost-effective diagnostic strategies and low-risk patient groups for ASB treatment.