What are the key considerations for managing urinary tract infections in pregnant women compared to non-pregnant adults?

Key considerations for managing urinary tract infections (UTIs) in pregnant women compared to non-pregnant adults include:

• Increased risk and complications: Pregnant women are at higher risk of developing UTIs and complications such as pyelonephritis, which can affect both maternal and fetal health. Therefore, prompt diagnosis and treatment are critical.
• Screening and treatment of asymptomatic bacteriuria: Unlike non-pregnant adults, pregnant women should be screened for and treated for asymptomatic bacteriuria to prevent progression to symptomatic infection and adverse pregnancy outcomes.
• Choice of antibiotics: Antibiotic selection in pregnancy must consider fetal safety, avoiding teratogenic or harmful drugs, while ensuring effective treatment of the infection.
• Diagnostic approach: Urine samples should be collected before starting antibiotics, using clean catch methods where possible, and sent for culture to guide therapy.
• Monitoring and follow-up: Pregnant women require close monitoring for treatment response and potential recurrence, with follow-up urine cultures to ensure eradication.
• Avoidance of prophylactic antibiotics unless recurrent infections occur: Routine prophylaxis is not recommended unless there are recurrent UTIs, balancing benefits and risks.

These considerations differ from non-pregnant adults, where asymptomatic bacteriuria is generally not treated, and antibiotic choices are less restricted. The management in pregnancy aims to protect both mother and fetus from infection-related complications.

Note: The provided NICE guideline excerpts focus primarily on children and do not directly address pregnancy-specific UTI management; however, these principles are consistent with UK clinical practice and NICE antimicrobial prescribing guidelines for pregnancy.