Antibiotics effective for urinary tract infection during pregnancy

Clinical question: 
How effective are antibiotics for symptomatic urinary tract infection (UTI) during pregnancy?
Bottom line: 
All the antibiotics studied were very effective. In most of the comparisons, there were no significant differences between the treatments with regard to cure rates, recurrent infection, incidence of preterm delivery, admission to neonatal intensive care unit, need for change of antibiotic or incidence of prolonged pyrexia. Complications were very rare. Antibiotics tested included penicillins, cephalosporins, aminoglycosides, antimetabolites, nitrofurantoin and fosfomycin trometamol.
Caveat: 
It was not possible to draw reliable conclusions as to which was the best class, route or regimen of antibiotic to treat symptomatic UTIs during pregnancy because of limitations in the primary data (quality and sample sizes). The main problems overall were the loss to follow-up (between 8% and 25%), performance of late microbiological studies and follow-up samples, and lack of reporting of important data about pregnancy outcomes.
Context: 
Urinary tract infections, including cystitis and pyelonephritis, are common in pregnancy and are serious complications that may lead to significant maternal and neonatal morbidity and mortality.
Review CD#: 
CD002256
PEARLS No: 
309
Date: 
May, 2011
Authored by: 
Brian R McAvoy