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UTI in Pregnancy — MRCGP AKT MCQ

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ModerateObstetricsUTI in PregnancyMRCGP AKTUKMLAPARAPSA

A woman who is 14 weeks pregnant has dysuria and urinary frequency without fever, vomiting or loin pain. She started empirical nitrofurantoin 48 hours ago, but her symptoms have not improved. Her midstream urine grows Escherichia coli resistant to nitrofurantoin but susceptible to amoxicillin. She has no penicillin allergy. What is the most appropriate antibiotic management?

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Correct answer: C — Change to amoxicillin 500 mg three times daily for 7 days

The correct answer is C. This is a symptomatic lower UTI without features of pyelonephritis. In pregnancy, NICE advises reviewing treatment when culture results become available and changing the antibiotic if the organism is resistant. Amoxicillin 500 mg three times daily for 7 days is appropriate when susceptibility is confirmed. Nitrofurantoin is normally first choice at this gestation, but continuing it would be ineffective because the isolate is resistant. Trimethoprim is not a NICE-recommended routine choice for lower UTI in pregnancy and is a folate antagonist, with particular concern during early pregnancy. Ciprofloxacin and doxycycline are not recommended NICE options for routine lower UTI treatment in pregnancy.

Reference: NICE. Urinary tract infection (lower): antimicrobial prescribing, NG109, section 1.4, Table 2: antibiotics for pregnant women aged 12 years and over. Published 2018; minor update May 2025. https://www.nice.org.uk/guidance/ng109/chapter/Recommendations