Tiêu đề UTI in pregnancy (symptomatic).pdf ✅

Version: 11 June 2024 National Antimicrobial Guideline, 4th Edition (2024) Clinical Pathways for Primary Care: Urinary Tract Infection in Pregnancy (Symptomatic) Assess for presence of pyelonephritis: High grade fever, nausea / vomiting, flank pain, leukocytosis, costovertebral tenderness Perform urinalysis Nit +ve OR Nit –ve, Leu +ve Unlikely UTI Consider other dx e.g. vaginitis Nit –ve AND Leu –ve Antibiotics Dosing Duration Remarks Nitrofurantoin* 50-100mg PO q6h (immediate release) OR 100mg PO q12h (modified release) 5 days Preferred Cephalexin 500mg q6h 5 days Preferred Amoxycillin / Clavulanate** 625mg PO q8h 5 days Alternative Ampicillin / Sulbactam 375-750mg PO q12h 5 days Alternative Cefuroxime 500mg PO q12h 5 days Alternative *Nitrofurantoin is contraindicated if eGFR is <30 ml/min and in third trimester. **Amoxycillin / Clavulanate is generally safe in pregnancy (category B) except for an increasing incidence of necrotizing enterocolitis in preterm babies and in babies born after premature rupture of membrane. 1. Consensus Guidelines on The Management of Urinary Tract Infections in Pregnancy 2021 2. UTI (lower): Antimicrobial Prescribing. NICE Guideline May 2022. 3. The WHO AWaRe (Access, Watch, Reserve) antibiotic book 2022. Suspected of urinary tract infection (ADULT, PREGNANT): Frequency, dysuria, hematuria, suprapubic pain, urgency, polyuria Probably UTI with no evidence of pyelonephritis Send urine C&S and start treatment Suspected pyelonephritis Refer for admission Review symptoms and repeat urine C&S 1-2 weeks after treatment completion if symptom persist