Duration of treatment for asymptomatic bacteriuria during pregnancy

Widmer M, Gülmezoglu AM, Mignini L, Roganti A

Published Online:

December 7, 2011

Asymptomatic bacteriuria is a urinary tract infection (without symptoms) common in pregnancy. If untreated, it can lead to pyelonephritis (kidney infection). Antibiotic treatment is recommended. This review aimed to identify whether single-dose antibiotic treatments are as effective as longer ones for maternal and newborn outcomes. The review of 13 studies, involving over 1622 women, found that a one-day regimen is significantly less effective than a seven-day regimen.

Abstract (click to read)

Background:

A Cochrane systematic review has shown that drug treatment of asymptomatic bacteriuria in pregnant women substantially decreases the risk of pyelonephritis and reduces the risk of preterm delivery. However, it is not clear whether single-dose therapy is as effective as longer conventional antibiotic treatment.

Objectives:

To assess the effects of different durations of treatment for asymptomatic bacteriuria in pregnancy.

Search strategy:

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 August 2011) and reference lists of identified articles.

Selection criteria:

Randomized and quasi-randomized trials comparing antimicrobial therapeutic regimens that differed in duration (particularly comparing single dose with longer duration regimens) in pregnant women diagnosed with asymptomatic bacteriuria.

Data collection and analysis:

We assessed trial quality and extracted data independently.

Main results:

We included 13 studies, involving 1622 women. All were comparisons of single-dose treatment with four- to seven-day treatments. The trials were generally of limited quality. The 'no cure rate' for asymptomatic bacteriuria in pregnant women was slightly higher for the single-dose than for the short-course treatment; however, these results were not statistically significant and showed heterogeneity. When comparing the trials that used the same antibiotic in both treatment and control groups with the trials that used different antibiotics in both groups, the 'no cure rate' risk ratio was similar. There was no statistically significant difference in the recurrence of asymptomatic bacteriuria rate between treatment and control groups. Slight differences were detected for preterm births and pyelonephritis although, apart from one trial, the sample size of the trials was inadequate. Single-dose treatment was associated with a decrease in reports of 'any side-effects' .

Authors' conclusions:

Single-dose regimen of antibiotics may be less effective than the seven-day regimen. Women with asymptomatic bacteriuria in pregnancy should be treated by the standard regimen of antibiotics until more data become available testing seven-day compared with three- or five-day regimens.

This record should be cited as:

Widmer M, Gülmezoglu AM, Mignini L, Roganti A. Duration of treatment for asymptomatic bacteriuria during pregnancy. Cochrane Database of Systematic Reviews 2011, Issue 12. Art. No.: CD000491. DOI: 10.1002/14651858.CD000491.pub2

Assessed as up to date:

November 9, 2011

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Primary Review Group:

Pregnancy and Childbirth Group

Health topics:

Infectious disease > Urinary tract infections > Treatment: asymptomatic infection

Kidney disease > Urinary tract infections > Treatment: asymptomatic infection

Pregnancy & childbirth > Infection during pregnancy > Urinary tract infections

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Duration of treatment for asymptomatic bacteriuria during pregnancy

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