November 2004 · Vol. 16, No. 11UTI in pregnancy: 6 questions to guide therapy
Crucial are treatment, test of cure, frequent screening until delivery, and antibiotic suppression, when indicated.
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Fast Track
Screen all pregnant women early; screen those with risk factors often.
A threshold of 100 CFL/mL raises the sensitivity of a urine culture in symptomatic patients.
When a rapid test is positive but the patient has no symptoms, treat only if urine culture is positive.
Make sure the urine culture is negative after either single-dose or other antibiotic treatment.
Change antibiotics based on urine culture sensitivity profiles.
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Katherine
T.
Chen,
MD, MPHAssistant Professor, Department of Obstetrics and Gynecology,
College of Physicians and Surgeons of Columbia University,
New York, NY
THE CASE: SIGNS AND SYMPTOMS
A 29–year–old nullipara at 18 weeks’ gestation complains of fevers and back pain. She had a diagnosis of urinary tract infection with sulfonamide-resistant Escherichia coli at 9 weeks of gestation, which was treated with nitrofurantoin, 100 mg by mouth twice a day for 7 days. A test of cure by urine culture was negative.
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