Treatment of asymptomatic bacteriuria

A. Amoxicillin-clavulanate (Augmentin) 500 mg PO BID for three days.

B. Nitrofurantoin (Macrodantin) 50 mg PO QID for seven days.

C. Cefixime (Suprax) 250 mg PO QD for three days.

D. Fosfomycin (Monural) 3 g PO as a single dose.

E. Relapse typically occurs in the first two weeks after treatment. Such infections should be treated with two weeks of oral antibiotics.

F. Suppressive therapy is recommended for women with persistent bacteriuria (ie, >2 positive urine cultures). Nitrofurantoin (Macrodantin) 50 to 100 mg orally at bedtime, for the duration of the pregnancy is one option, or cephalexin (Keflex) 250 to 500 mg orally at bedtime. A culture for test of cure is obtained one week after completion of therapy and then repeated monthly until completion of the pregnancy.

IV. Cystitis occurs in 0.3 to 1.3 percent of pregnant women. Bacteria are confined to the lower urinary tract in these patients.

A. Acute cystitis should be considered in any gravida with frequency, urgency, dysuria, hematuria, or suprapubic pain in the absence of fever and flank pain. Urine culture with a CFU count >102/mL should be considered positive on a midstream urine specimen with pyuria.

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