Antibiotics for pregnant women aged 12 years and over

Treatment

• Oral or intravenous antibiotics
  • oral antibiotics should be given first line if the person can take oral medicines, and the severity of their condition does not require intravenous antibiotics
  • if intravenous antibiotics then review intravenous antibiotics by 48 hours and consider stepping down to oral antibiotics where possible

Reassessment

• reassess if symptoms worsen at any time, or do not start to improve within 48 hours of taking the antibiotic, taking account of:
  • other possible diagnoses
  • any symptoms or signs suggesting a more serious illness or condition, such as sepsis
  • previous antibiotic use, which may have led to resistant bacteria.

Antibiotics for pregnant women aged 12 years and over

First-choice oral antibiotic2

• Cefalexin - 500 mg twice or three times a day (up to 1 to 1.5 g three or four times a day for severe infections) for 7 to 10 days

First-choice intravenous antibiotic (if vomiting, unable to take oral antibiotics, or severely unwell)2,3

• cefuroxime 750 mg to 1.5 g three or four times a day
  
  
• Second-choice antibiotics or combining antibiotics if susceptibility or sepsis a concern > consult local microbiologist
• 1 check British national formulary (BNF) for appropriate use and dosing in specific populations, for example, hepatic impairment and renal impairment, and administering intravenous antibiotics.
• 2 check any previous urine culture and susceptibility results and antibiotic prescribing and choose antibiotics accordingly.
• 3 review intravenous antibiotics by 48 hours and consider stepping down to oral antibiotics where possible.

Reference:

• NICE (October 2018). Pyelonephritis (acute): antimicrobial prescribing
• Public Health England (June 2021). Managing common infections: guidance for primary care