Top 4 Antibiotics For Uti When Pregnant 2017
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Antibiotics for UTI when pregnant are sometimes a necessary evil. However, some are better than others.
Recent research published in CMAJ on May 1, 2017, reveals interesting findings of taking antibiotics when expecting. Some findings were surprising, while others have confirmed the long-standing opinion about potential side-effects of taking antibiotics when pregnant.
Finding #1: Antibiotics are associated with 60% increase in the risk of miscarriage
Every pregnant woman regardless of whether she takes antibiotics or not, has about 5-6% chance of miscarriage. When you take antibiotics during early stages of pregnancy it seems to increase the risk up to 9-10%.
However, it is hard to say what increases your risk more: the underlying infection or the antibiotic treatment.
Finding # 2: Some antibiotics are better than others
According to the findings, the following antibiotic groups are associated with an increased risk of miscarriage:
The findings reveal that the following antibiotics have not been connected with an increased risk of miscarriage:
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Do I Really Need An Antibiotic
If youre expecting and suspect a urinary tract infection, do not try supplements to treat a UTI you and your unborn baby need antibiotics. While nonpregnant women or men with UTIs may attempt to forego antibiotics in favor of natural treatment options like cranberry supplements, probiotics, or vitamin C, this is not recommended for pregnant women. Without antibiotics its unlikely your infection will go away, especially since your immune system is compromised during pregnancy.
According to Dr. Reed, the increased risk of kidney infection makes antibiotics the best choice for treatment. The benefits of taking a pregnancy-safe antibioticand preventing a more serious infectiongreatly outweigh any possible risks.
Once you begin a course of antibiotics, there are also ways to help alleviate your symptoms until your infection improves.
You may use OTC urinary tract analgesics to manage the discomfort, Dr. Reed says. There isnt much evidence to support that natural supplements can prevent UTIs, but you can try cranberry supplements or probiotics. These OTC urinary tract analgesics are especially helpful the first day or two of an antibiotic course when women still experience dysuria, frequency and urgency because the antibiotics have not kicked in yet.
Its also a good idea to increase your water intake and get plenty of rest. Pregnant women may take Tylenol for any lower abdominal or back pain associated with UTIs.
Can A Uti Cause Contractions During Pregnancy
Urinary tract infections are not associated with preterm labor, according to research published in the Journal of the Chinese Medical Association. However, if a urinary tract infection is left untreated, it can progress to a kidney infection. And a kidney infection during pregnancy can modestly increase your chances of early contractions and delivery. Research published in the American Journal of Obstetrics & Gynecology notes that women diagnosed with acute pyelonephritis in pregnancy have a 10.3 percent chance of preterm delivery compared with the 7.9 percent chance among women without a kidney infection during pregnancy.
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How Can I Prevent A Bladder Infection
You may do everything right and still experience a urinary tract infection during pregnancy, but you can reduce the likelihood by doing the following:
- Drink 6-8 glasses of water each day and unsweetened cranberry juice regularly.
- Eliminate refined foods, fruit juices, caffeine, alcohol, and sugar.
- Take Vitamin C , Beta-carotene and Zinc to help fight infection.
- Develop a habit of urinating as soon as the need is felt and empty your bladder completely when you urinate.
- Urinate before and after intercourse.
- Avoid intercourse while you are being treated for a UTI.
- After urinating, blot dry , and keep your genital area clean. Make sure you wipe from the front toward the back.
- Avoid using strong soaps, douches, antiseptic creams, feminine hygiene sprays, and powders.
- Change underwear and pantyhose every day.
- Avoid wearing tight-fitting pants.
- Wear all-cotton or cotton-crotch underwear and pantyhose.
- Dont soak in the bathtub longer than 30 minutes or more than twice a day.
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Can I Prevent Utis
You can lower your risk of developing a UTI during pregnancy by:
- drinking plenty of fluids, especially water
- quickly treating any vaginal infection that may occur, including thrush or a sexually transmitted infection
Some women have also found the following tips helpful:
- urinate immediately after sex
- dont delay going to the toilet go as soon as you feel the need
- wipe from the front to the back after going to the toilet
- wear cotton underwear
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How Are Utis In Pregnancy Diagnosed
UTIs are diagnosed by doing a urine culture test that looks for bacteria, red cells and white cells in your urine . This is usually done in the first trimester and is different to the urine test to see if you are pregnant.
Your doctor will send a sample of your urine to the laboratory to be tested. If bacteria are found in the urine, the sample will be cultured and tested for antibiotic sensitivities to check which antibiotics will work best.
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How Are Utis Diagnosed
UTIs are diagnosed by taking a urine sample which is checked in a laboratory for bacteria. Your doctor may also perform a physical examination if they think you have an infection.
All pregnant women are offered a urine test, usually at their first antenatal visit or soon after. You may need to repeat the urine test if you have a history of UTIs have symptoms of a UTI have a contaminated sample or if your doctor thinks you are at high risk of developing a UTI. If you have frequent UTIs, you may also need additional tests such as an ultrasound of your kidneys.
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Group B Streptococcal Infection
Group B streptococcal vaginal colonization is known to be a cause of neonatal sepsis and is associated with preterm rupture of membranes, and preterm labor and delivery. GBS is found to be the causative organism in UTIs in approximately 5 percent of patients.31,32 Evidence that GBS bacteriuria increases patient risk of preterm rupture of membranes and premature delivery is mixed.33,34 A randomized, controlled trial35 compared the treatment of GBS bacteriuria with penicillin to treatment with placebo. Results indicated a significant reduction in rates of premature rupture of membranes and preterm delivery in the women who received antibiotics. It is unclear if GBS bacteriuria is equivalent to GBS vaginal colonization, but pregnant women with GBS bacteriuria should be treated as GBS carriers and should receive a prophylactic antibiotic during labor.36
Ethics Approval And Consent To Participate
Consent to use the publicly available data was obtained from Mumsnet, as the website has licence to use the content as they deem appropriate. Individual users could not provide consent due to the anonymity of the posts. Ethical approval was obtained from the University of Readings Research and Ethics Committee .
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Why It’s Common To Have A Uti In Pregnancy
Pregnancy increases your risk of all three types of urinary tract infection mentioned above.
Here’s why: Higher levels of the hormone progesterone decrease the muscle tone of the ureters , slowing the flow of urine. Plus, as your uterus enlarges it may compress the ureters, making it that much more difficult for urine to flow through them as quickly and as freely as usual.
Your bladder also loses tone during pregnancy. It becomes more difficult to completely empty your bladder, and your bladder becomes more prone to reflux, a condition where some urine flows back up the ureters toward the kidneys.
The upshot of these changes is that it takes longer for urine to pass through your urinary tract, giving bacteria more time to multiply and take hold before being flushed out, and it also becomes easier for the bacteria to travel up to your kidneys.
What’s more, during pregnancy your urine becomes less acidic and more likely to contain glucose, both of which boost the potential for bacterial growth.
Treatment From A Gp For Utis That Keep Coming Back
If your UTI comes back after treatment, or you have 2 UTIs in 6 months, a GP may:
- prescribe a different antibiotic or prescribe a low-dose antibiotic to take for up to 6 months
- prescribe a vaginal cream containing oestrogen, if you have gone through the menopause
- refer you to a specialist for further tests and treatments
In some people, antibiotics do not work or urine tests do not pick up an infection, even though you have UTI symptoms.
This may mean you have a long-term UTI that is not picked up by current urine tests. Ask the GP for a referral to a specialist for further tests and treatments.
Long-term UTIs are linked to an increased risk of bladder cancer in people aged 60 and over.
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When To See A Doctor For Uti In Pregnancy
|My first rule of thumb and one I teach every new mother, is to trust your intuition. If you think you have a UTI, call your doctor or midwife immediately. Being wrong is not the worst thing, and your doctor will understand.|
If you suspect you have a UTI, its best to see your doctor or midwife as soon as possible.
They will do a urinalysis from a clean catch urine sample that you provide. This will determine whether there are white blood cells , red blood cells and/or bacteria in your urine.
If the urinalysis comes back positive for WBCs and/or bacteria, your doctor should do a culture and antibiotic sensitivity test and prescribe a pregnancy safe antibiotic.
What Is A Urine Infection And What Are The Symptoms
A urine infection is caused by germs which get into your urine. Usually the germs have come from your skin, and travelled up the tubes of the urinary system. The symptoms may depend on how far up your system the germs have travelled. The germs may cause:
- Asymptomatic bacteriuria. In this situation bacteria are found in your urine but are not causing any symptoms. You will only know you have it if your urine is tested.
- Bladder infection . This is common, both in pregnant and non-pregnant women. Typical symptoms are pain when you pass urine and passing urine more often. You may also have other symptoms such as pain in your lower tummy , blood in your urine, and a high temperature .
- Kidney infection . This is uncommon but may occur as a complication from cystitis or asymptomatic bacteriuria. It is usually a more serious infection, making you feel very unwell. Some or all of the possible symptoms may occur, which include:
- Pain in your side over your kidney.
- Having a high temperature.
- Symptoms of cystitis as above.
- Feeling generally unwell.
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Do Utis Differ By Trimester
At week 6, UTI risk starts to go up, with two-fifths of UTIs occurring during the first trimester. Because of the likelihood of getting a UTI during the first trimester, the U.S. Preventive Services Task Force recommends that pregnant women have a urinalysis and urine culture at their first prenatal visit whether they have UTI symptoms or not. In the second trimester, about half as many pregnant women are diagnosed with a UTI as in the first trimester, according to the Centers for Disease Control and Prevention, and that number is almost halved again for the third trimester. However, 80 to 90 percent of acute kidney infections in pregnancy occur in the second and third trimesters, according to data published in the Archives of Medical Science, so pregnant women should have a repeat urine culture during the third trimester.
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Medications For The Treatment Of Urinary Tract Infection During Pregnancy
Antibiotic medications are frequently used to treat urinary tract infections in women who are pregnant. They are typically prescribed for three to 10 days, depending on the type of medication and the severity of the infection. Common antibiotics that have been approved for the treatment of urinary tract infections during pregnancy include:
- Penicillins: Penicillins, including amoxicillin, were once the principle treatment of choice for urinary tract infections, but are ineffective against E. coli-driven UTIs in up to 30 percent of cases. They are, however, useful against urinary tract infections caused by other bacteria, such as Staphylococcus saprophyticus or Enterococcus. Stubborn, drug-resistant infections may have to be addressed with Augmentin . Penicillins are typically prescribed for 10 days and are generally well tolerated by most patients. Side effects include diarrhea, nausea, stomach pain, and vaginal itching or discharge.
- Cephalosporins: Cephalosporins include medications such as cephalexin , cefuroxime and cefadrozil . These antibiotics are currently the most widely prescribed medications for UTIs, but can only be used in the first and second trimesters. Because of their potency, cephalosporins are usually prescribed for three to seven days and are well tolerated. Side effects of these medications include upset stomach, nausea, vomiting, and diarrhea.
Manufacturers Respond To The Fda
The FDA received at least three responses to its list ofphenazopyridine questions within a 6-month period. The ConsumerHealthcare Products Association asked the FDA to reviewphenazopyridine, but completely sidestepped the issue ofcarcinogenicity.11 A submission from PolymedicaPharmaceuticals asserted that urinarydiscomfort should be self-treatable, and further argued against warningpatients on product labels that they may need a concomitantantibacterial.12 Polymedica also claimed that phenazopyridinedosages of 190 to 195 mg are safe and effective, but did not submitclinical dosage studies to support its assertions. Polymedica arguedagainst including any carcinogenesis statement. In short, the submissionwas entirely laudatory about phenazopyridine, although it did notreport newly conducted clinical studies, as would have been required bythe FDA to establish safety and efficacy.
A brief submission from Johnson & Johnson made essentially the same arguments as Polymedica, denying theneed for carcinogenicity labeling.13 This submission also failed to include new clinical studies providing evidence of safety and efficacy.
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Risks Of Taking Antibiotics While Pregnant
Antibiotics are important for helping your body fight bacterial infections. Some types of antibiotics might be unsafe during pregnancy, including:
- Losing consciousness
- Difficulty breathing
If you have symptoms from taking antibiotics such as an allergic reaction, you should talk to your doctor. Tightness in the throat, swelling, and having a hard time breathing are signs of anaphylaxis. Anaphylaxis is a severe allergic reaction and you should go to your nearest hospital right away.
Antibiotic resistance. Overusing antibiotics or not taking them the way your doctor recommends can cause bacteria to become resistant to the medicine. This means that the antibiotics might not work as well as they should, which can make your infection harder to treat.
To make sure this doesnt happen, your doctor wonât give you antibiotics for a virus like the common cold. This is because antibiotics only treat infections from bacteria and using them for a virus can lead to superbugs. Your doctor also might not give you an antibiotic for minor infections like a chest infection, ear infection, or a sore throat unless it becomes serious.
Faqs About Utis Answered By Your Doctors Online Team
Can UTIs clear up in a day?
It usually takes around 2-3 days or more to notice an improvement in the symptoms, but starting treatment on time ensures a quick and complete recovery.
How long does it take antibiotics to work for UTIs?
It usually takes 2-3 days for the symptoms to improve after starting the antibiotics. To prevent a UTI from recurring or prevent re-infection, it is best to complete the course of the prescribed antibiotics.
What is the best antibiotic for UTIs in diabetics?
Diabetic patients are more likely to get urinary tract infections due to frequent urination, high blood sugar level, and an impaired immune system. A high blood glucose concentration in urine makes the patients more prone to developing UTIs as glucose is a perfect medium for bacteria to grow and multiply. Nitrofurantoin is a popular choice of antibiotic for such patients.
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Physiological Changes Of Pregnancy And Its Association With Urinary Tract Infections
Pregnancy increases the risk of UTIs. At around 6th week of pregnancy, due to the physiological changes of pregnancy the ureters begin to dilate. This is also known as hydronephrosis of pregnancy, which peaks at 22-26 weeks and continues to persist until delivery. Both progesterone and estrogens levels increase during pregnancy and these will lead to decreased ureteral and bladder tone. Increased plasma volume during pregnancy leads to decrease urine concentration and increased bladder volume. The combination of all these factors lead to urinary stasis and uretero-vesical reflux. Glycosuria in pregnancy is also another well-known factor which predisposes mothers to UTI.
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