Efficacy of long-term antimicrobial prophylaxis after acute pyelonephritis in Pregnancy

Abstract

The efficacy of antimicrobial prophylaxis for recurrent urinary infection after an episode of acute febrile pyelonephritis was assessed in 27 pregnant women. Immediately following a 2-week treatment course for acute pyelonephritis, low-dose prophylaxis with a proper antimicrobial agent taken at bedtime daily was continued until 1 month after delivery. 23 women received 50 mg of nitrofurantoin, and 2 each were given 250 mg of amoxycillin and 250 mg of cephalexin, respectively. The treatment regimens were well tolerated and there were no breakthrough infections during a total of 7.8 patient-years of treatment. These results show that long-term low-dose antimicrobial prophylaxis is highly effective in this population at high risk of recurrent acute pyelonephritis.

Urinary Tract Infection and Bacteriuria in Pregnancy

“…Prophylactic antimicrobial therapy should be strongly considered to reduce the risk of recurrent pyelonephritis. [122][123][124][125]137 In a study of 400 pregnant patients with pyelonephritis, 2.7% of women were readmitted for recurrent pyelonephritis, all of whom were noncompliant with antimicrobial prophylaxis, reinforcing the importance of this therapy. 17 In patients who do not respond to culturedirected treatment, alternative diagnoses should be considered and an imaging study such as a renal ultrasound should be obtained to rule out renal abscess, nephrolithiasis, or other structural abnormality, although it is important to remember that some degree of hydronephrosis is expected in pregnancy.…”

Asymptomatic Bacteriuria and Symptomatic Urinary Tract Infections During Pregnancy

“…This course should be followed by suppressive therapy until delivery [46,47]. As with ASB and cystitis, follow-up after treatment is important.…”

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“…First, susceptibility testing guided the pharmacist to choose the cephalosporin group, as this infection caused by multidrug-resistant E. coli was sensitive to all generations of tested cephalosporin 7 . Factors related to the drug were safety and the effectiveness of the high bactericidal concentrations in the urinary tract related to the minimal risk of the resistance of gram-negative bacteria flora to cephalexin 8 . In their study, P fauand Sacks strongly recommended the use of cephalexin as a prophylaxis for recurrent UTI in pregnant women 9 .…”