1.       Clean voided specimen for urine culture done at the initial visit on all patients.

 

2.       Urine cultures done every trimester throughout pregnancy, on:

 

·       Patients who have had one urinary tract infection during the

     current pregnancy

·       A history of chronic Urinary tract infections

·       Patients with sickle cell trait or disease

·       Patients with previous kidney disease or diabetes

 

3.               Any patient with >1+ protein, >1+ LE or + nitrites. 

 

4.       Any patient with frequency and urgency.

 

5.       African Americans with history of UTIs should be screened for G6PD.

 

Asymptomatic UTI - characterized by a positive culture on a clean voided specimen with no symptoms present.

 

Acute UTI - characterized by one or more of the following: dysuria with or after voiding; frequency and or urgency; positive nitrites on urine dipstick.

 

Chronic UTI - recurrence of positive culture after documented therapy and or one acute UTI followed by a subsequent positive culture.

 

 

 

1.       Before prescribing treatment, check for drug allergies.

 

2.       Rule out pyelonephritis (fever and or chills; nausea and vomiting; costovertebral angle tenderness; hematuria ).  If suspected, refer patient to ER immediately for evaluation.

 

3.       Asymptomatic and Acute UTI

          a.       Macrobid 100 mg BID X 7  days

          b.       Cephalexin 500 mg TID X 3 days

          c.        Bactrim DS 1 BID X 7 days (not in third trimester)

          d.       Consider screening AA for G6PD

4.       Chronic UTI

a.       Ampicillin 500 mg q day for remainder of pregnancy

b.       Macrobid 100 mg at bedtime q day for remainder of pregnancy

 

5.       Follow-up should include a culture or microscope exam of a clean voided urine specimine 2-4 weeks after completing treatment

 

 

 

 

Prepared in conjunction with the

Division of Maternal-Fetal Medicine

Duke University Medical Center

                                                                                                                                  Director

 

 

                                                                                                                                   Date

1/16/07                                                                   

Urinary Tract Infections