[Current approaches to diagnosis and treatment of urinary tract infections during pregnancy]

Abstract

Urinary tract infections (UTIs) are one of the leading causes of extragenital pathology in pregnant women, occurring in to 5-7% of women. Despite the asymptomatic course in many cases, even uncomplicated UTIs carry the risk of complications for both the woman and the fetus due to the high risk of ascending infection. Therefore, timely diagnosis and rational therapy are key to preventing adverse outcomes. The diagnosis is based on characteristic clinical and laboratory signs. The basis for the treatment of UTIs is timely antibacterial therapy (ABT). At the same time, approaches to the empirical selection of a specific drug are identical between different types of infections, due to their etiological similarity. Rational ABT varies depending on the severity of the UTIs. In case of complicated course requiring hospitalization, preference is given to parenteral forms, while in those with uncomplicated UTIs, oral drugs are chosen in order to achieve high compliance. Oral ABT for uncomplicated UTI in pregnant women include nitrofurans, fosfomycin trometamol, and third-generation cephalosporins. Among the latter, cefixime seems to be most rational due to high sensitivity of the main uropathogens (E. coli), high efficiency, safety and compliance with treatment in pregnant women.

Keywords: antibacterial therapy; asymptomatic bacteriuria; cefixime; cystitis; pregnancy; pyelonephritis; urinary tract infections.