Single-dose amoxycillin in the treatment of bacteriuria in pregnancy and the puerperium--a controlled clinical trial

iSingle Dose Antibiotic Therapy for Urinary Infections during Pregnancy: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

BACKGROUND

During pregnancy, urinary infections are an important cause of maternofetal morbimortality and may lead to several complications.

OBJECTIVES

Verify whether the use of antibiotic therapy in a single dose when compared to multiple doses in lower tract urinary infections during pregnancy is effective to obtain microbiological cure.

SEARCH STRATEGY

Online databases were searched. Keywords used were "single-drug dose", "antibiotic", "fosfomycin", "amoxicillin", "trimethoprim", "pregnancy" and "urinary tract infection".

SELECTION CRITERIA

Studies were included if: were randomized controlled trials, population was pregnant woman, microbiological cure was attained and one of the treatment groups received single-dose antibiotic therapy.

DATA COLLECTION AND ANALYSIS

Preselected studies have been independently read by pairs, and data were extracted according to a predetermined sheet. The Cochrane tool was used for the risk of bias.

MAIN RESULTS

1063 women from 9 studies were included. The primary outcome was the microbiological cure attested by urine culture. When compared to the multiple-day use of antibiotics, the single-dose treatment has shown statistically similar results in reaching culture cure (OR 1.02, 95% IC 0.73-1.44).

CONCLUSION

The current study has shown that the use of single dose treatment for lower tract urinary infections during pregnancy can be recommended, specially using fosfomycin.

Duration of treatment for asymptomatic bacteriuria during pregnancy

BACKGROUND

A previous Cochrane systematic review has shown that antibiotic drug treatment of asymptomatic bacteriuria in pregnant women substantially decreases the risk of pyelonephritis and reduces the risk of preterm delivery. However, it is not clear whether single-dose therapy is as effective as longer conventional antibiotic treatment.

OBJECTIVES

To assess the effects of different durations of treatment for asymptomatic bacteriuria in pregnancy.

SEARCH METHODS

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 August 2015) and reference lists of identified articles.

SELECTION CRITERIA

Randomized and quasi-randomized trials comparing antimicrobial therapeutic regimens that differed in duration (particularly comparing single dose with longer duration regimens) in pregnant women diagnosed with asymptomatic bacteriuria.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. We assessed the quality of the evidence using the GRADE approach.

MAIN RESULTS

We included 13 studies, involving 1622 women. All were comparisons of single-dose treatment with short-course (four- to seven-day) treatments. The risk of bias of trials included in this review was largely unclear, and most trials were at high risk of performance bias. The quality of the evidence was assessed using the GRADE approach. When the any antibiotic agent was used, the 'no cure' rate for asymptomatic bacteriuria in pregnant women was slightly lower for the short-course treatment over the single-dose treatment, although there was evidence of statistical heterogeneity (average risk ratio (RR) 1.28, 95% confidence interval (CI) 0.87 to 1.88; women = 1502, studies = 13; I² = 56%; very low quality evidence). Data from only good quality trials also showed better cure rates with short (four- to seven-day) regimens of the same microbial agent (average RR 1.72, 95% CI 1.27 to 2.33; women = 803, studies = two; I² = 0%; high quality evidence). There was no clear difference in the recurrence of asymptomatic bacteriuria rate between treatment and control groups, whether the same or different microbial agents were used (RR 1.13, 95% CI 0.77 to 1.66; 445 women studies = eight; I² = 0%; very low quality evidence). Differences were detected for low birthweight babies, favoring a short course (four- to seven-day treatment) of the same microbial agent, although the data come from a single trial (RR 1.65, 95% CI 1.06 to 2.57; 714 women; high quality evidence), but no differences were observed for preterm delivery (RR 1.17, 95% CI 0.77 to 1.78; women = 804; studies = three; I² = 23%; moderate quality) or pyelonephritis (RR 3.09, 95% CI 0.54 to 17.55; women = 102; studies = two; I² = 0%; very low quality evidence). Finally, single-dose treatment of any microbial agent was associated with a decrease in reports of 'any side effects' (RR 0.70, 95% CI 0.56 to 0.88; 1460 women, studies = 12; I² = 9%; low quality evidence). Evidence was downgraded for risk of bias concerns in trials contributing data and for imprecise effect estimates (wide confidence intervals crossing the line of no effect, and in some cases, small studies with few events).

AUTHORS' CONCLUSIONS

A single-dose regimen of antibiotics may be less effective than a short-course (four- to seven-day) regimen, but more evidence is needed from large trials measuring important outcomes, such as cure rate. Women with asymptomatic bacteriuria in pregnancy should be treated by the standard regimen of antibiotics until more data become available testing seven-day treatment compared with shorter courses of three- or five-day regimens.

Duration of treatment for asymptomatic bacteriuria during pregnancy

BACKGROUND

A Cochrane systematic review has shown that drug treatment of asymptomatic bacteriuria in pregnant women substantially decreases the risk of pyelonephritis and reduces the risk of preterm delivery. However, it is not clear whether single-dose therapy is as effective as longer conventional antibiotic treatment.

OBJECTIVES

To assess the effects of different durations of treatment for asymptomatic bacteriuria in pregnancy.

SEARCH METHODS

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 August 2011) and reference lists of identified articles.

SELECTION CRITERIA

Randomized and quasi-randomized trials comparing antimicrobial therapeutic regimens that differed in duration (particularly comparing single dose with longer duration regimens) in pregnant women diagnosed with asymptomatic bacteriuria.

DATA COLLECTION AND ANALYSIS

We assessed trial quality and extracted data independently.

MAIN RESULTS

We included 13 studies, involving 1622 women. All were comparisons of single-dose treatment with four- to seven-day treatments. The trials were generally of limited quality. The 'no cure rate' for asymptomatic bacteriuria in pregnant women was slightly higher for the single-dose than for the short-course treatment; however, these results were not statistically significant and showed heterogeneity. When comparing the trials that used the same antibiotic in both treatment and control groups with the trials that used different antibiotics in both groups, the 'no cure rate' risk ratio was similar. There was no statistically significant difference in the recurrence of asymptomatic bacteriuria rate between treatment and control groups. Slight differences were detected for preterm births and pyelonephritis although, apart from one trial, the sample size of the trials was inadequate. Single-dose treatment was associated with a decrease in reports of 'any side-effects' .

AUTHORS' CONCLUSIONS

Single-dose regimen of antibiotics may be less effective than the seven-day regimen. Women with asymptomatic bacteriuria in pregnancy should be treated by the standard regimen of antibiotics until more data become available testing seven-day compared with three- or five-day regimens.

Treatments for symptomatic urinary tract infections during pregnancy

BACKGROUND

Urinary tract infections, including pyelonephritis, are serious complications that may lead to significant maternal and neonatal morbidity and mortality. There is a large number of drugs, and combination of them, available to treat urinary tract infections, most of them tested in non-pregnant women. Attempts to define the optimal antibiotic regimen for pregnancy have, therefore, been problematic.

OBJECTIVES

The objective of this review was to determine, from the best available evidence from randomised controlled trials, which agent is the most effective for the treatment of symptomatic urinary tract infections during pregnancy in terms of cure rates, recurrent infection, incidence of preterm delivery and premature rupture of membranes, admission to neonatal intensive care unit, need for change of antibiotic, and incidence of prolonged pyrexia.

SEARCH STRATEGY

We searched the Cochrane Pregnancy and Childbirth Group Trials Register (November 2009) and reference lists of articles.

SELECTION CRITERIA

We considered all trials where the intention was to allocate participants randomly to one of at least two alternative treatments for any symptomatic urinary tract infection.

DATA COLLECTION AND ANALYSIS

Both review authors assessed trial quality and extracted data.

MAIN RESULTS

We included 10 studies, recruiting a total of 1125 pregnant women. In most of the comparisons there were no significant differences between the treatments under study with regard to cure rates, recurrent infection, incidence of preterm delivery, admission to neonatal intensive care unit, need for change of antibiotic and incidence of prolonged pyrexia. When cefuroxime and cephradine were compared, there were better cure rates (29/49 versus 41/52) and fewer recurrences (20/49 versus 11/52) in the cefuroxime group. There was only one other statistically significant difference when comparing outpatient versus inpatient treatment. Gestational age at birth was greater in women from the outpatient group (38.86 versus 37.21), while birthweight was on average greater in the inpatient group (3120 versus 2659).

AUTHORS' CONCLUSIONS

Although antibiotic treatment is effective for the cure of urinary tract infections, there are insufficient data to recommend any specific drug regimen for treatment of symptomatic urinary tract infections during pregnancy. All the antibiotics studied were shown to be very effective in decreasing the incidence of the different outcomes. Complications were very rare. All included trials had very small sample sizes to reliably detect important differences between treatments. Future studies should evaluate the most promising antibiotics, in terms of class, timing, dose, acceptability, maternal and neonatal outcomes and costs.

Urinary Tract Infections During Pregnancy

OBJECTIVE

To provide a comprehensive review of urinary tract infections (UTIs) during pregnancy. All aspects of UTIs, including epidemiology, pathogenesis, resistance, clinical features, diagnosis, treatment, and prevention, were reviewed.

DATA SOURCES

MEDLINE (1966–August 2003) and Cochrane Library searches were performed using the key search terms urinary tract infection, pyelonephritis, cystitis, asymptomatic bacteriuria, and resistance.

STUDY SELECTION AND DATA EXTRACTION

All article abstracts were evaluated for relevance. Only articles pertaining to pregnancy were included. The majority of published literature were review articles; the number of original clinical studies was limited.

DATA SYNTHESIS

UTIs are the most common bacterial infections during pregnancy. They are characterized by the presence of significant bacteria anywhere along the urinary tract. Pyelonephritis is the most common severe bacterial infection that can lead to perinatal and maternal complications including premature delivery, infants with low birth weight, fetal mortality, preeclampsia, pregnancy-induced hypertension, anemia, thrombocytopenia, and transient renal insufficiency. Enterobacteriaceae account for 90% of UTIs. The common antibiotics used are nitrofurantoin, cefazolin, cephalexin, ceftriaxone, and gentamicin.

CONCLUSIONS

Therapeutic management of UTIs in pregnancy requires proper diagnostic workup and thorough understanding of antimicrobial agents to optimize maternal outcome, ensure safety to the fetus, and prevent complications that lead to significant morbidity and mortality in both the fetus and the mother.

Gastric and duodenal ulcers during pregnancy

The frequency, symptoms, and complication rate of PUD seem to decrease during pregnancy. Yet clinicians often have to treat dyspepsia or pyrosis of undetermined origin during pregnancy because the frequency of pyrosis significantly increases during pregnancy, and clinicians reluctantly perform EGD during pregnancy for pyrosis to differentiate reliably between GERD and PUD. Dyspepsia or pyrosis during pregnancy is initially treated with dietary and lifestyle modifications. If the symptoms do not remit with these modifications, sucralfate or antacids, preferably magnesium-containing or aluminum-containing antacids, should be administered. Histamine2 receptor antagonists are recommended when symptoms are refractory to antacid or sucralfate therapy. Ranitidine seems to be a relatively safe H2 receptor antagonist. If symptoms continue despite H2 receptor antagonist therapy, the patient should be evaluated for possible EGD or PPI therapy. Pregnant women with hemodynamically significant upper gastrointestinal bleeding or other worrisome clinical findings should undergo EGD. Indications for surgery include ulcer perforation, ongoing active bleeding from an ulcer requiring transfusion of six or more units of packed erythrocytes, gastric outlet obstruction refractory to intense medical therapy, and a malignant gastric ulcer without evident metastases.

Treatments for symptomatic urinary tract infections during pregnancy

BACKGROUND

Urinary tract infections, including pyelonephritis, are serious complications that can result in significant maternal and neonatal morbidity and mortality. There is a large number of drugs, and combination of them, available to treat urinary tract infections, most of them tested in non-pregnant women. Attempts to define the optimal antibiotic regimen for pregnancy has, therefore, been problematic.

OBJECTIVES

The objective of this review was to try to determine, from the best available evidence from randomized control trials, which agent is most effective for the treatment of symptomatic urinary tract infections during pregnancy in terms of cure rates, recurrent infection, incidence of preterm delivery and premature rupture of membranes, admission to neonatal intensive care unit, need for change of antibiotic, and incidence of prolonged pyrexia.

SEARCH STRATEGY

The Cochrane Pregnancy and Childbirth Group trials register (January 2003) and reference lists of articles were searched.

SELECTION CRITERIA

All trials were considered where the intention was to allocate participants randomly to one of at least two alternative treatments for any symptomatic urinary tract infection.

DATA COLLECTION AND ANALYSIS

Both reviewers assessed trial quality and extracted data.

MAIN RESULTS

Eight studies were included, recruiting a total of 905 pregnant women. In most of the comparisons there were no significant differences between studied treatments with regard to cure rates, recurrent infection, incidence of preterm delivery and premature rupture of membranes, admission to neonatal intensive care unit, need for change of antibiotic and incidence of prolonged pyrexia. Only when cefuroxime and cephradine were compared, were there better cure rates (29/49 versus 41/52) and less recurrences (20/49 versus 11/52) in the cefuroxime group, but the sample size is insufficient to ensure that differences found in the effect of the drugs were real.

REVIEWER'S CONCLUSIONS

Although antibiotic treatment is effective for the cure of urinary tract infections, there are insufficient data to recommend any specific treatment regimen for symptomatic urinary tract infections during pregnancy. All the antibiotics studied were shown to be very effective in decreasing the incidence of outcomes measured. Complications were very rare. All included trials had very small sample sizes to try to detect important differences between treatments. Future studies should evaluate the most promising antibiotics, in terms of class, timing, dose, acceptability, maternal and neonatal outcomes and costs.

Duration of treatment for asymptomatic bacteriuria during pregnancy

BACKGROUND

A Cochrane systematic review has shown that drug treatment of asymptomatic bacteriuria in pregnant women substantially decreases the risk of pyelonephritis and reduces the risk of preterm delivery. However, it is not clear whether single dose therapy is as effective as longer conventional antibiotic treatment.

OBJECTIVES

The objective of this review was to assess the effects of different durations of treatment for asymptomatic bacteriuria in pregnancy.

SEARCH STRATEGY

We searched the Cochrane Pregnancy and Childbirth Group trials register, the Cochrane Controlled Trials Register and the reference lists of articles.

SELECTION CRITERIA

Randomised and quasi-randomised trials comparing antimicrobial therapeutic regimens that differed in duration (particularly comparing single dose with longer duration regimens) in pregnant women diagnosed with asymptomatic bacteriuria.

DATA COLLECTION AND ANALYSIS

Trial quality was assessed and data were extracted independently by the reviewers.

MAIN RESULTS

Eight studies involving over 400 women were included. All were comparisons of single dose treatment with four to seven day treatments. The trials were generally of poor quality. No difference in 'no-cure' rate was detected between single dose and short course (4-7 day) treatment for asymptomatic bacteriuria in pregnant women (relative risk 1.13, 95% confidence interval 0.82 to 1.54) as well as in the recurrent asymptomtic bacteriuria (relative risk 1.08, 95% confidence interval 0.70 to 1.66). However these results showed significant heterogeneity. No differences were detected for preterm births and pyelonephritis although sample size of trials was small. Longer duration treatment was associated with an increase in reports of adverse effects (relative risk 0.53, 95% confidence interval 0.31 to 0.91).

REVIEWER'S CONCLUSIONS

There is not enough evidence to evaluate whether single dose or longer duration doses are more effective in treating asymptomatic bacteriuria in pregnant women. Because single dose has lower cost and increases compliance, this comparison should be explored in a properly sized randomized controlled trial.

Urinary tract infections in pregnancy

Although pregnancy does not increase the prevalence of ASB in women, it does enhance the progression rate from asymptomatic to symptomatic disease. Furthermore, ASB is associated with preterm delivery. Given the fact that identification and eradication of ASB in pregnant women can lower the likelihood of pyelonephritis and prevent preterm delivery, every gravida should be systematically screened for ASB and appropriately treated. In the authors' opinion, a first-trimester urine culture remains the screening test of choice; reliance on symptoms to prompt screening is inadequate because the state of pregnancy can provoke frequency and nocturia. Multiple antibiotic regimens for ASB are safe during pregnancy and effective.

Detection, significance, and therapy of bacteriuria in pregnancy. Update in the managed health care era

Profound physiologic and anatomic changes of the urinary tract during pregnancy contribute to the increased risk for symptomatic urinary tract infection in women with bacteriuria. Asymptomatic bacteriuria is the major risk factor for developing symptomatic UTIs during pregnancy and may be associated with adverse effects on maternal and fetal health. Because most symptomatic UTIs develop in women with bacteriuria earlier in pregnancy, treatment of bacteriuria is undertaken to prevent symptomatic infections. All pregnant women should be screened at the first antenatal visit, which is reliably and inexpensively done with a dipstick culture. Short-course therapy should be given to women with bacteriuria and clearance of bacteriuria should be documented after therapy is complete. Failure to eliminate bacteriuria with repeated therapy or recurrence with the same organism is indicative of renal parenchymal infection or a structural abnormality. All women with persistent bacteriuria or recurrent infection should have follow-up cultures and a urologic evaluation after delivery.

Urinary tract infections complicating pregnancy

Urinary tract infections (asymptomatic bacteriuria, cystitis, and pyelonephritis) are frequently encountered medical complications of pregnancy. The majority of infections in pregnancy are asymptomatic; however, even covert bacteriuria places the mother at risk for low birth weight and preterm birth. Pyelonephritis can result in significant maternal and fetal morbidity and mortality. Therefore, all pregnant women should be screened for asymptomatic bacteriuria, and urinary tract infections should be promptly treated to prevent adverse pregnancy outcome. This article reviews the diagnosis, etiology, treatment, and complications associated with urinary tract infections in pregnancy.

Lower urinary tract dysfunction in pregnancy: a review

It has long been observed that pregnancy may influence the development and course of urinary tract disorders. The physiological and anatomical changes inherent in normal pregnancy and the changing hormonal environment are generally assumed to play a role in the pathogenesis of urinary tract symptomatology. The purpose of this review is to examine the reported effect(s) of pregnancy on the lower urinary tract and to evaluate the possible role of pregnancy and delivery in lower urinary tract dysfunction.

Recommended treatment for urinary tract infection in pregnancy

OBJECTIVE

To establish and recommend a therapeutic regimen for the treatment of urinary tract infection (UTI) in pregnancy based on the published studies.

DATA SOURCES

An English-language literature search employing MEDLINE, Index Medicus, and bibliographic reviews of the references obtained were searched (key terms: urinary tract infection, UTI, pregnancy, bacteriuria).

STUDY SELECTION AND DATA EXTRACTION

All identified human studies dealing with bacteriuria or UTI in pregnancy were analyzed.

DATA SYNTHESIS

Limited data are available regarding the appropriate antibiotic management of UTI in pregnancy. Single-dose cure rates with amoxicillin are approximately 80 percent. Trimethoprim/sulfamethoxazole provides cure rates of greater than 80 percent. Cephalosporins and nitrofurantoin produce variable results.

CONCLUSIONS

We recommend separating pregnant subjects with UTI into two groups. Those with asymptomatic bacteriuria can be treated with a single dose of an antimicrobial to which the organism is susceptible. For those with symptomatic UTI, we recommend amoxicillin 500 mg tid for three days. Urine cultures should be repeated seven days following therapy to assess cure or failure. Well-designed studies need to be performed, comparing single-dose and three-day therapy for UTI in pregnancy.

Management of urinary tract infections in pregnancy: a review with comments on single dose therapy

Most investigators agree that the adverse effects of urinary tract infections in pregnancy can be abrogated by effective early detection and treatment. However, the optimal methods for screening and treatment remain controversial. Although single-dose therapy has not been applied to pregnant women with acute pyelonephritis, most but not all studies which have compared single-dose with longer courses of beta-lactam or other antibiotics in pregnant asymptomatic bacteriuric women have shown no differences in outcome. This paper reviews recent trials of single-dose treatment of bacteriuria in pregnant women.

Epidemiology, natural history, and management of urinary tract infections in pregnancy

The urinary tract undergoes profound physiologic and anatomic changes during pregnancy that facilitate the development of symptomatic UTIs in women with bacteriuria. Although the adverse effects of asymptomatic bacteriuria on maternal and fetal health continue to be debated, it is clear that asymptomatic bacteriuria is the major risk factor for developing symptomatic UTI and that symptomatic infections are associated with significant maternal and fetal risks. Because the majority of symptomatic UTIs develop in women with bacteriuria earlier in pregnancy, treatment of bacteriuria is undertaken to prevent symptomatic infections. All women should be screened at the first antenatal visit, which is reliably and inexpensively done with a dipstick culture. Short-course therapy is as effective as prolonged therapy and should be followed with a repeat culture to document clearing of the bacteriuria. Failure to eliminate bacteriuria with repeated therapy or recurrence with the same organism is indicative of renal parenchymal infection or a structural abnormality. All women with persistent bacteriuria or recurrent infection should have follow-up cultures and a complete urologic evaluation after delivery.

Single dose fosfomycin trometamol versus multiple dose nitrofurantoin in pregnant women with bacteriuria: preliminary results

Pregnancy induces anatomical and physiological changes in the urinary tract. In this condition a bacteriuria, even asymptomatic, may lead more frequently to pyelonephritis. Asymptomatic bacteriuria in pregnant women has therefore got to be treated. According to recent studies, long course antibiotherapy did not prove to be more effective than a single-dose one in the case of non-complicated bacteriuria. Moreover, the maternal and foetal toxicity should be reduced in the latter regimen. In this paper we present the preliminary results of our study comparing a single-dose treatment by fosfomycin trometamol (3 g) and nitrofurantoin (200 mg per day during a week).

Bacteriuria in the puerperium. Risk factors, screening procedures, and treatment programs

Screening for bacteriuria by culture of voided midstream urine was done in 6803 puerperal women; significant growth was found in 8.1%. The urine was recollected by suprapubic aspiration and bacteriuria was confirmed in 52%, corresponding to an incidence of bladder bacteriuria of 3.7%. A history of past urinary tract infection, bacteriuria in pregnancy, operative delivery, epidural anesthesia, and bladder catheterization increased the risk of postpartum urinary tract infection. Only 21% of the women complained of dysuria; this symptom occurred significantly more often after operative delivery and in patients with previous urinary tract infection. Two hundred fifty-one women with bladder bacteriuria were subjected to different treatments by randomized allocation: 153 patients with amoxicillin-susceptible bacterias were selected for amoxicillin treatment of 1, 3, and 10 days' duration. The cure rates were 84%, 94%, and 98%, respectively; the single-dose therapy was significantly less effective than 10 days' treatment (p less than 0.05). Forty-six women with amoxicillin-resistant bacterial infections received cephalexin or nitrofurantoin therapy of 7 days' duration; the cure rate was 91%. Fifty-two women served as control subjects and received no treatment. Ten weeks later 27% still had persistent bacteriuria in their suprapubic aspiration control specimens. All therapeutic regimens except the single-dose method showed a cure rate that was significantly higher than the spontaneous cure rate (p less than 0.05). Multiparity seemed to be a predisposing factor for persistence of bacteriuria. The study indicates that puerperal patients with positive midstream urine specimens should not be automatically treated, but more thoroughly examined. In cases of confirmed bladder bacteriuria, treatment should be recommended; 3 days' therapy appears to be sufficient.

Postpartum bacteriuria. A multicenter evaluation of different screening procedures and a controlled short-course treatment trial with amoxycillin

A total of 10,909 puerperal women from 6 different hospitals were screened for bacteriuria by culture of voided midstream urine (MSU), and a significant growth was found in 881 patients (8.1%). In 731 cases the urine was reexamined by using suprapubic aspiration (SPA), and in only 354 (48%) of the samples the diagnosis of bacteriuria was confirmed. The contamination rate of the MSU samples varied from 46 to 69% between the different hospitals, indicating that in the postpartum period positive MSU findings would necessitate more thorough examination in order to confirm the diagnosis of urinary tract infection. In our study, suprapubic aspiration was found to be a simple and acceptable method without any side effects. Confirmed bacteriuria occurred in 3.2% of the women. Operative delivery (Cesarean section, forceps and vacuum extractor delivery), epidural anesthesia and bladder catheterization increased the risk of bacteriuria in the postpartum period. Only 27% of the women with positive bladder urine complained of dysuria and this symptom was significantly more common in women who had been catheterized. 230 patients with confirmed bacteriuria with amoxycillin-sensitive bacterias participated in a randomized short-course treatment trial: 114 women received 3 days treatment with amoxycillin (1.5 g/day), 116 received the traditional 10 days therapy (750 mg amoxycillin/day). Both antibiotic regimens were observed to be effective with a cure rate of 96 and 98%, respectively. Short-course antibiotic treatment should thus be recommended to puerperal women with urinary tract infections since this avoids prolonged drug exposure to the lactating mother.

Single-dose antimicrobial therapy in the treatment of asymptomatic bacteriuria in pregnancy

Fifty obstetric patients with asymptomatic bacteriuria were treated by single-dose antimicrobial therapy. The immediate cure rate was 84% and the recurrence rate was 12%. Seven of the eight patients in whom single-dose treatment failed responded to subsequent 7-day therapy with the same drug, indicating renal involvement. A 50% recurrence rate in the group of patients in whom single-dose treatment failed was compared with a 5% recurrence rate in the group cured by single-dose therapy, which indicates that failure with single-dose antimicrobial therapy can serve as a therapeutic test to identify patients at high risk for recurrent bacteriuria and its sequelae during pregnancy. It is concluded that single-dose antimicrobial therapy is a safe and effective way to treat asymptomatic bacteriuria in pregnant patients without urologic problems in their history.