Updates about the treatment of urinary infections during pregnancy





Pregnancy; Anti-bacterial agents; Urinary tract infections; Prenatal care.


Urinary tract infections are common during pregnancy and can lead to negative outcomes, such as pre-eclampsia, prematurity and low birth weight. Therefore, health professionals must diagnose them and propose appropriate antimicrobial treatment. The objective of this article is to review recent information on urinary tract infections during pregnancy, emphasizing the best antimicrobial therapy for each case. To this end, articles from the last five years were reviewed on the SciELO and PubMed platforms, available in English or Portuguese. Within the 27 studies found, those that addressed topics other than those covered in this research were excluded. As a result, 10 articles were selected. In addition, guiding reference documents on the topic were included, such as national and international protocols and guidelines. From them it was realized that, during pregnancy, it is essential to screen for asymptomatic bacteriuria through urine culture. The diagnosis of cystitis and pyelonephritis is clinical, through anamnesis and physical examination. In these cases, urine culture must be performed to identify the causative agent, which is especially important if resistant bacteria are found. There is different information regarding treatment in the articles researched. However, most texts considered nitrofurantoin, cephalosporins, phosphomycin and amoxicillin as adequate and safe options for the treatment of asymptomatic bacteriuria or cystitis, with duration of therapy depending on the chosen antimicrobial. For cases of pyelonephritis, the importance of hospitalizing the pregnant woman was explained, with cephalosporins selected as initial therapy. In short, there is conflicting information regarding the choice of antimicrobials and the recommended treatment duration for urinary tract infections during pregnancy. Therefore, more research is required to disseminate more accurate information, improve treatment and avoid bacterial selection.


Azami, M., Jaafari, Z., Masoumi, M., Shohani, M., Badfar, G., Mahmudi, L., & Abbasalizadeh, S. (2019). The etiology and prevalence of urinary tract infection and asymptomatic bacteriuria in pregnant women in Iran: a systematic review and Meta-analysis. BMC urology, 19(1), 43. https://doi.org/10.1186/s12894-019-0454-8

Bonkat. G., Bartoletti, R., Bruyère, F., Cai, T., Geerlings, S. E., Köves B., Kranz, J., Schubert, S., Pilatz, A., Veeratterapillay, R., & Wagenlehner, F. (2023). EAU Guidelines on Urological Infections. [Versão digital em Adobe Reader]. Recuperado de https://d56bochluxqnz.cloudfront.net/documents/full-guideline/EAU-Guidelines-on-Urological-infections-2023.pdf

Bookstaver, P. B., Bland, C. M., Griffin, B., Stover, K. R., Eiland, L. S., & McLaughlin, M. (2015). A Review of Antibiotic Use in Pregnancy. Pharmacotherapy, 35(11), 1052–1062. https://doi.org/10.1002/phar.1649

Emami, A., Javanmardi, F., & Pirbonyeh, N. (2020). Antibiotic resistant profile of asymptomatic bacteriuria in pregnant women: a systematic review and meta-analysis. Expert review of anti-infective therapy, 18(8), 807–815. https://doi.org/10.1080/14787210.2020.1759420

Habak, P. J., & Griggs, Jr, R. P. (2023). Urinary Tract Infection in Pregnancy. In StatPearls. StatPearls Publishing.

Jameson J, & Fauci A. S., & Kasper D. L., & Hauser S. L., & Longo D. L., & Loscalzo J. (2018). Harrison's Principles of Internal Medicine, 20e. McGraw Hill.

Konwar, M., Gogtay, N. J., Ravi, R., Thatte, U. M., & Bose, D. (2022). Evaluation of efficacy and safety of fosfomycin versus nitrofurantoin for the treatment of uncomplicated lower urinary tract infection (UTI) in women - A systematic review and meta-analysis. Journal of chemotherapy (Florence, Italy), 34(3), 139–148. https://doi.org/10.1080/1120009X.2021.1938949

Lee, A. C., Mullany, L. C., Quaiyum, M., Mitra, D. K., Labrique, A., Christian, P., Ahmed, P., Uddin, J., Rafiqullah, I., DasGupta, S., Rahman, M., Koumans, E. H., Ahmed, S., Saha, S. K., Baqui, A. H., & Projahnmo Study Group in Bangladesh (2019). Effect of population-based antenatal screening and treatment of genitourinary tract infections on birth outcomes in Sylhet, Bangladesh (MIST): a cluster-randomised clinical trial. The Lancet. Global health, 7(1), e148–e159. https://doi.org/10.1016/S2214-109X(18)30441-8

Mattos, P. C. (2015). Tipos de revisão de literatura. Unesp, 1-9. https://www.fca.unesp.br/Home/Biblioteca/tipos-de-evisao-de-literatura.pdf

Ministério da Saúde (2022). Manual da Gestação de Alto Risco: Versão Preliminar. [Versão digital em Adobe Reader]. https://bvsms.saude.gov.br/bvs/publicacoes/manual_gestacao_alto_risco.pdf

Nicolle, L. E., Gupta, K., Bradley, S. F., Colgan, R., DeMuri, G. P., Drekonja, D., Eckert, L. O., Geerlings, S. E., Köves, B., Hooton, T. M., Juthani-Mehta, M., Knight, S. L., Saint, S., Schaeffer, A. J., Trautner, B., Wullt, B., & Siemieniuk, R. (2019). Clinical Practice Guideline for the Management of Asymptomatic Bacteriuria: 2019 Update by the Infectious Diseases Society of America. Clinical infectious diseases: an official publication of the Infectious Diseases Society of America, 68(10), e83–e110. https://doi.org/10.1093/cid/ciy1121

Pfau, A., & Sacks, T. G. (1992). Effective prophylaxis for recurrent urinary tract infections during pregnancy. Clinical infectious diseases: an official publication of the Infectious Diseases Society of America, 14(4), 810–814. https://doi.org/10.1093/clinids/14.4.810

Prefeitura de Belo Horizonte (2019). Protocolo: Pré Natal e Puerpério, (2a ed.) [Versão digital em Adobe Reader]. /https://prefeitura.pbh.gov.br/sites/default/files/estrutura-de-governo/saude/Protocolo_pre-natal_perperio-14-06-2019.pdf

Rossi, P., Cimerman, S., Truzzi, J. C., Cunha, C. A. D., Mattar, R., Martino, M. D. V., Hachul, M., Andriolo, A., Vasconcelos Neto, J. A., Pereira-Correia, J. A., Machado, A. M. O., & Gales, A. C. (2020). Joint report of SBI (Brazilian Society of Infectious Diseases), FEBRASGO (Brazilian Federation of Gynecology and Obstetrics Associations), SBU (Brazilian Society of Urology) and SBPC/ML (Brazilian Society of Clinical Pathology/Laboratory Medicine): recommendations for the clinical management of lower urinary tract infections in pregnant and non-pregnant women. The Brazilian journal of infectious diseases: an official publication of the Brazilian Society of Infectious Diseases, 24(2), 110–119. https://doi.org/10.1016/j.bjid.2020.04.002

Rother, E. T. (2007). Revisão sistemática x revisão narrativa. Acta Paulista de Enfermagem, 20(2). https://doi.org/10.1590/S0103-21002007000200001

Sabih, A., & Leslie, S. W. (2023). Complicated Urinary Tract Infections. In StatPearls. StatPearls Publishing.

Schulz, G. S., Schütz, F., Spielmann, F. V. J., da Ros, L. U., de Almeida, J. S., & Ramos, J. G. L. (2022). Single-dose antibiotic therapy for urinary infections during pregnancy: A systematic review and meta-analysis of randomized clinical trials. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics, 159(1), 56–64. https://doi.org/10.1002/ijgo.14087

Smaill, F. M., & Vazquez, J. C. (2019). Antibiotics for asymptomatic bacteriuria in pregnancy. The Cochrane database of systematic reviews, 2019(11), CD000490. https://doi.org/10.1002/14651858.CD000490.pub4

Orozco C., Javier E., Picón J., Yelson A., & Garcés-Salamanca, Christi T. (2018). Staphylococcus sciuri, una causa infrecuente de sepsis materna. Revista chilena de obstetricia y ginecología, 83(3), 291-294. https://dx.doi.org/10.4067/s0717-75262018000300291

Yan, L., Jin, Y., Hang, H., & Yan, B. (2018). The association between urinary tract infection during pregnancy and preeclampsia: A meta-analysis. Medicine, 97(36), e12192. https://doi.org/10.1097/MD.0000000000012192



How to Cite

ARAÚJO, C. S. .; LELIS, A. E. M. .; SOUZA, V. P. B. de .; MACHADO, C. J. . Updates about the treatment of urinary infections during pregnancy. Research, Society and Development, [S. l.], v. 12, n. 12, p. e148121244097, 2023. DOI: 10.33448/rsd-v12i12.44097. Disponível em: https://www.rsdjournal.org/index.php/rsd/article/view/44097. Acesso em: 26 feb. 2024.



Health Sciences