Asymptomatic bacteriuria in pregnancy - Screening and treatment |
| Publication: 19/03/2021 |
| Next review: 19/03/2024 |
| Clinical Guideline |
| CURRENT |
| ID: 6903 |
| Approved By: IAPG |
| Copyright© Leeds Teaching Hospitals NHS Trust 2021 |
This Clinical Guideline is intended for use by healthcare professionals within Leeds unless otherwise stated. |
ASYMPTOMATIC BACTERIURIA IN PREGNANCY: SCREENING AND TREATMENT
NICE recommends that all pregnant women with asymptomatic bacteriuria (ASB) should receive a seven day course of antibiotics to prevent persistent bacteriuria, preterm birth, and low birth weight.
DIAGNOSTICS
All pregnant women should be offered screening at the time of booking.
All urine samples for Microbiology must be freshly collected and sent in a sterile red top (boric acid) container, as per normal MSU collection instructions.
Requesting on ICE: select one of the following from the antenatal urine culture (reason for sending) menu:
| All patients (at booking) |
MSU sent as ‘ASB screen 1’ |
|
Patients with bacteriuria present on the 1st screen |
MSU sent as ‘ASB screen 2’ |
|
Women who have Group B Strep isolated in their urine (including on a single screen) |
Initial course of oral antibiotics directed by the sensitivity results and then ensure intra-partum antibiotic prophylaxis1 is offered to all these women |
|
ASB screen result with ‘mixed growth’, or with different organisms |
Send repeat MSU of that screen (i.e. if Screen 1 is mixed enteric flora, send a repeat sample as ‘ASB screen 1’) |
|
Women seen in the Preterm prevention clinic |
MSU sent as ‘preterm prevention clinic’ sample |
|
All women treated for asymptomatic bacteriuria in pregnancy |
Send a ‘test of cure’ MSU on completion of treatment (within seven days of finishing antibiotics) |
If symptomatic please send MSU stating symptomatic and refer to the UTI in pregnancy guideline.
EMPIRICAL TREATMENT
Empirical treatment should not be given for asymptomatic bacteriuria in pregnancy. If the patient becomes symptomatic please refer to the relevant UTI in pregnancy guideline.
DIRECTED THERAPY
When ASB has been confirmed with 2 screening MSUs (same organism and susceptibilities) please use the table below to select the appropriate agent as per the susceptibility results.
| Order of preference |
Antibacterial and dose |
Notes |
|
Duration: 7 days |
||
|
1st line |
Nitrofurantoin PO 50mg 6-hourly |
Avoid after 36 weeks gestation3 |
|
2nd line |
Amoxicillin |
Avoid in penicillin allergy |
|
3rd line |
Trimethoprim PO 200mg 12-hourly |
Avoid before 12 weeks gestation |
|
4th line |
Cefalexin |
Avoid in penicillin allergy (unless known to tolerate cephalosporins) |
|
Please contact Microbiology to discuss further options if required. |
||
Please discuss with a senior obstetrician if the ‘test of cure’ sample returns the same result as the ASB screens.
FOOTNOTES
- Please see intrapartum prophylaxis guidance here
- Nitrofurantion should not be used if CrCl <45 mL/min. Do not rely on eGFR as this may over-estimate renal function
- The BNF states to “avoid at term - may produce neonatal haemolysis”. Author consensus was to use 36 weeks.
| |
Provenance
| Record: | 6903 |
| Objective: | |
| Clinical condition: | Asymptomatic bacteriuria in pregnancy |
| Target patient group: | |
| Target professional group(s): | Pharmacists Secondary Care Doctors |
| Adapted from: |
Evidence base
- https://extranet.who.int/rhl/topics/preconception-pregnancy-childbirth-and-postpartum-care/antenatal-care/who-recommendation-antibiotics-asymptomatic-bacteriuria#:~:text=A%20seven%2Dday%20antibiotic%20regimen,birth%20and%20low%20birth%20weight.
- https://www.nice.org.uk/guidance/ng109/resources/visual-summary-pdf-6544021069
- Robertson AW, Duff P. The nitrite and leukocyte esterase tests for the evaluation of asymptomatic bacteriuria in obstetric patients. Obstet Gynecol 1988; 71(6 Pt 1):878-81.
- https://www.nice.org.uk/guidance/ng109/resources/urinary-tract-infection-lower-antimicrobial-prescribing-pdf-66141546350533
- Saving Babies Lives Version 2: https://www.england.nhs.uk/wp-content/uploads/2019/07/saving-babies-lives-care-bundle-version-two-v5.pdf
- https://cks.nice.org.uk/urinary-tract-infection-lower-women#!scenario:4
- https://obgyn.onlinelibrary.wiley.com/doi/full/10.1111/1471-0528.14821
Approved By
IAPG
Document history
LHP version 1.2
Related information
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