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Treatments for symptomatic urinary tract infections during pregnancy

  • Review
  • Intervention

Authors


Abstract

Background

Urinary tract infections, including pyelonephritis, are serious complications that may lead to 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.

Objectives

The objective of this review was to try to determine, from the best available evidence from randomized control trials, which agent is the 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.

Search strategy

We searched the Cochrane Pregnancy and Childbirth Group Trials Register (January 2006) and reference lists of articles. We updated this search on 8 September 2009 and added the results to the awaiting classification section.

Selection criteria

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.

Data collection and analysis

Both review authors assessed trial quality and extracted data.

Main results

Nine studies were included, recruiting a total of 997 pregnant women. In most of the comparisons there were no significant differences between the treatments under study with regard to cure rates, recurrent infection, incidence of preterm delivery, admission to neonatal intensive care unit, need for change of antibiotic and incidence of prolonged pyrexia. Only when cefuroxime and cephradine were compared, there were better cure rates (29/49 versus 41/52) and fewer 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.

Authors' conclusions

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 the different outcomes. Complications were very rare. All included trials had very small sample sizes to reliably 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.

[Note: The two citations in the awaiting classification section of the review may alter the conclusions of the review once assessed.]

Plain language summary

Treatments for symptomatic urinary tract infections during pregnancy

Antibiotics are very effective at clearing urinary tract infections in pregnancy, and complications are very rare.

Infections in the urinary tract are common in pregnancy. These include infections with no symptoms (asymptomatic bacteriuria), cystitis (bladder infection) and pyelonephritis (kidney infection). Such infections can cause some serious complications for the woman, and may lead to problems for the baby. The review of trials found that several types of antibiotic had very high cure rates of cystitis or pyelonephritis during pregnancy, while complications from treatment were very rare. However, the studies could not show if any particular drug was preferable.

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