In pregnancy, what is the recommended management of urinary tract infections?

• A. Screen and treat asymptomatic bacteriuria with pregnancy-safe antibiotics and treat symptomatic UTIs promptly; avoid certain antibiotics in pregnancy.
• B. Do not screen asymptomatic bacteriuria; treat only symptomatic UTIs.
• C. Use tetracyclines for asymptomatic bacteriuria.
• D. Avoid antibiotics entirely during pregnancy.

Answer: (A)

In pregnancy, infections of the urinary tract are taken very seriously because a bacteriuria can progress to pyelonephritis and raise risks for both mother and baby. The best management is to screen for asymptomatic bacteriuria and treat it with antibiotics that are safe in pregnancy, even if the patient feels well. Treating asymptomatic bacteriuria reduces the chance of developing a more serious infection later. Any symptomatic urinary tract infection should be treated promptly to relieve symptoms and prevent complications.

When selecting therapy, certain antibiotics are avoided in pregnancy due to potential fetal harm, such as tetracyclines and fluoroquinolones, and trimethoprim-sulfamethoxazole is avoided in the first trimester and near term. Safer options typically include pregnancy-safe beta-lactams and cephalosporins, and nitrofurantoin can be used with appropriate timing considerations. After treatment, a follow-up urine culture is often done to confirm clearance.