Urinary Tract Infection (UTI) in Pregnancy
Standard Treatment Guidelines and Essential Medicines List for South Africa, Hospital Level, Adults, Updated for the 2023 Edition
CYSTITIS
O23.1
DESCRIPTION
This condition usually presents with lower abdominal pain, frequency of micturition, and/or dysuria. There are no features of sepsis, e.g., fever. Urine dipstick testing usually shows nitrites, with/without leukocytes; and/or blood.
GENERAL MEASURES
Encourage oral fluid intake.
Midstream urine for microscopy, culture and sensitivity.
MEDICINE TREATMENT
Empiric treatment (symptoms present with nitrites positive AND leukocytes positive on dipstick):
- Fosfomycin, oral, 3 g as a single dose
LoE:IIIbxlix; LoE:Ibl
OR
- Nitrofurantoin, oral, 100 mg, 6 hourly for 5 days.
LoE:IIbli
REFERRAL/CONSULTATION
No response to treatment, or resistant organism on culture.
PYELONEPHRITIS, ACUTE
O23.0
DESCRIPTION
This condition is more serious and may result in preterm labour.
Features of pyelonephritis include:
- temperature ≥38ºC.
- renal angle tenderness (often bilateral).
- other features of sepsis, i.e. vomiting, tachypnoea, tachycardia, confusion and hypotension.
GENERAL MEASURES
Admit to hospital.
Ensure adequate hydration with intravenous fluids, up to 3 L of sodium chloride 0.9% over 24 hours.
Midstream urine for microscopy, culture and sensitivity.
MEDICINE TREATMENT
Empiric therapy:
- Ceftriaxone, IV, 1 g, daily for 48 hours, or until fever subsides.
OR
- Gentamicin, IV, 6 mg/kg, daily (ensure normal renal function).
Switch to oral therapy as soon as the patient is able to take oral fluids:
- Amoxicillin/clavulanic acid, oral, 875/125 mg 12-hourly for 7 days.
Change antibiotics according to culture and sensitivity results. After treatment, ensure that two urine specimens are negative to confirm eradication.
Standard Treatment Guidelines and Essential Medicines List for South Africa, Adult Hospital Level, 2025-9 Review_Version 2.0_26 March 2026
Chapter 6 Obstetrics_6.19 Urinary Tract Infection (UTI) in Pregnancy