Symptomatic UTI Protocol (Pregnancy)
Primary care triage framework for symptomatic pregnant individuals presenting with frequency, dysuria, hematuria, suprapubic pain, urgency, or polyuria.
🚨 Step 1: Pyelonephritis Severity Screen
Assess immediately for upper urinary tract involvement or systemic illness before evaluating local bladder symptoms.
Check any presenting signs of Pyelonephritis:
🔬 Step 2: Urinalysis Track Selector
Select the laboratory dipstick profile to identify probable infection tracks.
Management Strategy: Probably UTI
- Confirmed symptomatic presentation with no clinical evidence of pyelonephritis.
- Send a urine specimen for formal Culture & Sensitivity (C&S) and start empirical antibiotic treatment immediately.
- Follow-up: Review patient symptoms and repeat a urine C&S 1-2 weeks after treatment completion if clinical symptoms persist.
💊 Recommended Outpatient Antimicrobial Dosage
Gestational prescription limits. The standard course duration is strictly 5 – 7 days for all selections.
| Antibiotic Option | Dosing Regimen | Duration | Obstetric Safety Remarks & Contraindications |
|---|---|---|---|
| Nitrofurantoin* |
50 – 100mg PO q6h (Immediate Release) OR 100mg PO q12h (Modified Release) |
5 – 7 Days |
Preferred Choice • Reasonable to offer in the first trimester if no appropriate alternatives are available. • Contraindications: Absolute if eGFR < 30 ml/min. Must be completely avoided in the third trimester. |
| Cephalexin | 1 – 2g / day PO split across 2 – 4 divided doses | 5 – 7 Days |
Preferred Choice Safe, highly effective line across all stages of pregnancy. |
| Amoxicillin / Clavulanate** | 625mg PO q8h | 5 – 7 Days |
Alternative Choice • Generally safe in pregnancy (FDA Category B). • Warning: Linked with an increasing incidence of necrotizing enterocolitis (NEC) in preterm babies and infants born after premature rupture of membranes (PROM). |
| Ampicillin / Sulbactam | 375 – 750mg PO q12h | 5 – 7 Days | Alternative Choice |
| Cefuroxime | 500mg PO q12h | 5 – 7 Days | Alternative Choice |