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. 2010 Sep 8;2010(9):CD007855.
doi: 10.1002/14651858.CD007855.pub2.

Different antibiotic regimens for treating asymptomatic bacteriuria in pregnancy

Valerie T Guinto  1 , Blanca De Guia, Mario R Festin, Therese Dowswell
Affiliations

Different antibiotic regimens for treating asymptomatic bacteriuria in pregnancy

Valerie T Guinto et al. Cochrane Database Syst Rev. .

Abstract

Background: Asymptomatic bacteriuria occurs in 5% to 10% of pregnancies and, if left untreated, can lead to serious complications.

Objectives: To assess which antibiotic is most effective and least harmful as initial treatment for asymptomatic bacteriuria in pregnancy.

Search strategy: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (March 2010) and reference lists of retrieved studies.

Selection criteria: Randomized controlled trials comparing two antibiotic regimens for treating asymptomatic bacteriuria.

Data collection and analysis: Review authors independently screened the studies for inclusion and extracted data.

Main results: We included five studies involving 1140 women with asymptomatic bacteriuria. We did not perform meta-analysis; each trial examined different antibiotic regimens and so we were not able to pool results. In a study comparing a single dose of fosfomycin trometamol 3 g with a five-day course of cefuroxime, there was no significant difference in persistent infection (risk ratio (RR) 1.36, 95% confidence interval (CI) 0.24 to 7.75), shift to other antibiotics (RR 0.08, 95% CI 0.00 to 1.45), or in allergy or pruritus (RR 2.73, 95% CI 0.11 to 65.24). A comparison of seven-day courses of 400 mg pivmecillinam versus 500 mg ampicillin, both given four times daily, showed no significant difference in persistent infection at two weeks or recurrent infection, but there was an increase in vomiting (RR 4.57, 95% CI 1.40 to 14.90) and women were more likely to stop treatment early with pivmecillinam (RR 8.82, 95% CI 1.16 to 66.95). When cephalexin 1 g versus Miraxid(R) (pivmecillinam 200 mg and pivampicillin 250 mg) were given twice-daily for three days, there was no significant difference in persistent or recurrent infection. A one- versus seven-day course of nitrofurantoin resulted in more persistent infection with the shorter course (RR 1.76, 95% CI 1.29 to 2.40), but no significant difference in symptomatic infection at two weeks, nausea, or preterm birth. Comparing cycloserine with sulphadimidine, no significant differences in symptomatic, persistent, or recurrent infections were noted.

Authors' conclusions: We cannot draw any definite conclusion on the most effective and safest antibiotic regimen for the initial treatment of asymptomatic bacteriuria in pregnancy. One study showed advantages with a longer course of nitrofurantoin, and another showed better tolerability with ampicillin compared with pivmecillinam; otherwise, there was no significant difference demonstrated between groups treated with different antibiotics. Given this lack of conclusive evidence, it may be useful for clinicians to consider factors such as cost, local availability and side effects in the selection of the best treatment option.

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Conflict of interest statement

One of the authors, Mario F Festin, is co‐author of a trial we included in the review (Lumbiganon 2009) and was not involved in assessing eligibility for inclusion or data extraction for this trial.

Figures

1
1
Methodological quality summary: review authors' judgements about each methodological quality item for each included study.
2
2
Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.
1.2
1.2. Analysis
Comparison 1 Fosfomycin trometamol versus cefuroxime, Outcome 2 Persistent infection.
1.4
1.4. Analysis
Comparison 1 Fosfomycin trometamol versus cefuroxime, Outcome 4 Shift to another antibiotic.
1.8
1.8. Analysis
Comparison 1 Fosfomycin trometamol versus cefuroxime, Outcome 8 Adverse effect: allergy or pruritus.
2.2
2.2. Analysis
Comparison 2 Pivmecillinam versus ampicillin, Outcome 2 Persistent infection.
2.3
2.3. Analysis
Comparison 2 Pivmecillinam versus ampicillin, Outcome 3 Recurrent infection.
2.6
2.6. Analysis
Comparison 2 Pivmecillinam versus ampicillin, Outcome 6 Adverse effect: nausea.
2.7
2.7. Analysis
Comparison 2 Pivmecillinam versus ampicillin, Outcome 7 Adverse effect: vomiting.
2.8
2.8. Analysis
Comparison 2 Pivmecillinam versus ampicillin, Outcome 8 Adverse effect: diarrhea.
2.10
2.10. Analysis
Comparison 2 Pivmecillinam versus ampicillin, Outcome 10 Adverse effect: prematurely stopping treatment.
3.1
3.1. Analysis
Comparison 3 1‐day nitrofurantoin versus 7‐day nitrofurantoin, Outcome 1 Symptomatic infection.
3.2
3.2. Analysis
Comparison 3 1‐day nitrofurantoin versus 7‐day nitrofurantoin, Outcome 2 Persistent infection.
3.5
3.5. Analysis
Comparison 3 1‐day nitrofurantoin versus 7‐day nitrofurantoin, Outcome 5 Adverse effect: nausea.
3.10
3.10. Analysis
Comparison 3 1‐day nitrofurantoin versus 7‐day nitrofurantoin, Outcome 10 Preterm delivery.
4.2
4.2. Analysis
Comparison 4 Pivampicillin/pivmecillinam (Miraxid) versus cephalexin, Outcome 2 Persistent infection.
4.3
4.3. Analysis
Comparison 4 Pivampicillin/pivmecillinam (Miraxid) versus cephalexin, Outcome 3 Recurrent infection.
5.1
5.1. Analysis
Comparison 5 Cycloserine versus sulphadimidine, Outcome 1 Symptomatic infection.
5.2
5.2. Analysis
Comparison 5 Cycloserine versus sulphadimidine, Outcome 2 Persistent infection.
5.3
5.3. Analysis
Comparison 5 Cycloserine versus sulphadimidine, Outcome 3 Recurrent infection.
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