Bacteriuria during pregnancy, including asymptomatic disease, is associated with higher risk of pyelonephritis (compared to the risk in nonpregnant women) and of some obstetrical complications, such as low birth weight and preterm delivery. Treatment reduced these risks. All women testing positive for bacteriuria should be treated empirically with antimicrobial therapy targeted at Escherichia coli infection.26 Safe agents for empirical therapy include penicillins, cephalosporins, and nitrofur-antoin (Table 47-8). Sulfonamides and ampicillin or amoxicillin also have been used, but increasing bacterial resistance to these agents renders them second-line

choices. Avoid quinolones owing to the theoretical risk of bone and cartilage malformations. Avoid trimethoprim and sulfamethoxazole during organogenesis (since antifolate drugs have been associated with congenital malformations) and near term

due to theoretical risk of neonatal jaundice. Once culture and sensitivity results are available, change the antimicrobial regimen if necessary. Recommend standard 3-day or longer antimicrobial therapy because there is insufficient evidence among pregnant

women to support 1-day regimens. Repeat urine culture 10 days after completion of therapy for bacteriuria.

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