Treatments for symptomatic urinary tract infections during pregnancy

Abstract

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, the Cochrane Controlled Trials Register 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. Trial quality assessment and data extraction were performed by the two reviewers. Five studies were included. 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 antibiotic and incidence of incidence of prolonged pyrexia. 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 of 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.