Different antibiotic regimens for treating asymptomatic bacteriuria in pregnancy

Department of Obstetrics and Gynecology, University of the Philippines College of Medicine-Philippine General Hospital, Taft Avenue, Manila, Philippines, 1000.
Cochrane database of systematic reviews (Online) (Impact Factor: 6.03). 09/2010; 9(9):CD007855. DOI: 10.1002/14651858.CD007855.pub2
Source: PubMed


Between 5% and 10% of pregnant women have bacteria in their urine without symptoms of infection (asymptomatic bacteriuria). If left untreated, women may go on to develop serious complications such as kidney infection or preterm birth. In this review we looked at studies comparing different antibiotic treatments for asymptomatic bacteriuria to see which antibiotics or which course of the same antibiotics (shorter versus longer courses) were most effective for reducing infection. We also looked at side effects such as vomiting. The studies included in this review failed to demonstrate any newer antibiotic or regimen which would be better than the older antibiotics and the traditional regimen. We included five randomized controlled trials involving 1140 women with urine test results showing asymptomatic bacteriuria. Each of the five studies looked at different antibiotics; thus, we have not pooled the results. Four of the comparisons (fosfomycin versus cefuroxime; pivmecillinam versus ampicillin; cephalexin versus Miraxid® (pivmecillinam 200 mg and pivampicillin 250 mg); and cycloserine versus sulphadimidine) showed no definite advantage of one antibiotic over another for treating infection, side effects, or safety. Ampicillin compared with pivmecillinam resulted in less vomiting and was thus better tolerated by the women in one study. There was however no difference in curing present infection and preventing recurring infection in women who took ampicillin compared with those who took pivmecillinam. In another study comparing a one-day versus a seven-day course of nitrofurantoin, the longer course was better in treating bacteria in urine during pregnancy. Women receiving the shorter course had more persistent infection but no clear difference in symptomatic infection at two weeks, nausea or preterm birth.

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Available from: Valerie Guinto, Oct 08, 2014
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    ABSTRACT: Urinary tract infections (UTIs) are among the most common types of bacterial infection in outpatient medicine. Rising rates of antibiotic resistance and a better understanding of the ecological adverse effects (collateral damage) of antibiotics warrant a reevaluation of the treatment recommendations for uncomplicated UTI. The new S3 guideline contains updated recommendations. The new S3 guideline is based on a review of publications on uncomplicated UTI retrieved by a systematic search of the Medline and Cochrane Library databases. Guidelines from abroad were also considered in the review. Uncomplicated UTI is classified as either uncomplicated cystitis (UC) or uncomplicated pyelonephritis (UP). The choice of a suitable antibiotic is determined by the following main criteria: the patient's individual risk profile and prior antibiotic treatment, if any; the spectrum of pathogens and antibiotic susceptibility; the proven efficacy of the antibiotic; the ecological adverse effects (collateral damage) of antimicrobial therapy; the side effects for the patient under treatment. On the basis of these criteria, co-trimoxazole/trimethoprim and fluoroquinolones can no longer be recommended as first-line empirical treatment for UC. Rather, the new recommended treatment of first choice consists of fosfomycin-trometamol, nitrofurantoin, or pivmecillinam. High-dose fluoroquinolones are still recommended, however, as first-line oral treatment for UP. Asymptomatic bacteriuria should only be treated in exceptional situations such as pregnancy or before urological procedures that will probably injure the mucosa of the urinary tract. The new S3 guideline on uncomplicated UTI incorporates a forward-looking approach to the use of antibiotics in treating this common type of infection. It is intended to bring about a sustained improvement in the quality of care.
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