What is the role of macrolides in the treatment of urinary tract infection (UTI) during pregnancy?

Updated: Aug 17, 2021
  • Author: Raisa O Platte, MD, PhD; Chief Editor: Edward David Kim, MD, FACS  more...
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Answer

Macrolides are not first-line agents for UTI in pregnancy. However, they are well tolerated by mother and fetus. A meta-analysis concluded that although antibiotic treatment is effective in patients with UTIs, the data are insufficient to recommend any specific regimen for treatment of symptomatic UTIs during pregnancy. [28, 29] All of the antibiotics studied were effective in terms of both increasing cure rates of UTI in pregnancy and decreasing the incidence of associated adverse outcomes. Current regimens are summarized in Table 1 below.

Table. Treatment Regimens for Pregnant Women with UTI (Open Table in a new window)

First-line therapy

  • Nitrofurantoin monohydrate/macrocrystals 100 mg orally twice daily for 5-7 days or

  • Amoxicillin 500 mg orally twice daily (alternative: 250 mg orally three times daily) for 5-7 days or

  • Amoxicillin-clavulanate 500/125 mg orally twice daily for 3-7 days (alternative: 250/125 mg orally three times daily for 5-7 days) or

  • Cephalexin 500 mg orally twice daily for 3-7 days

Second-line therapy

  • Fosfomycin 3 g orally as single dose with 3-4 oz. of water


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