What therapy is recommended for prophylaxis against recurrent infection in pregnant women with acute pyelonephritis (kidney infection)?

Updated: Jul 01, 2021
  • Author: Tibor Fulop, MD, PhD, FACP, FASN; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Answer

Postcoital therapy with cephalexin or nitrofurantoin is recommended for prophylaxis against recurrent infection. If the initial infection requires a second agent for clearing the infection or a recurrent infection occurs, suppressive therapy until delivery is indicated with nitrofurantoin (50 mg or 100 mg at bedtime). Recurrent infection or persistent bacteriuria is an indication for urological evaluation 3-6 months after delivery.

Caution should be used when prescribing nitrofurantoin for prophylaxis, as adverse effects of this medication include peripheral neuropathy, pulmonary toxicity, and hepatotoxicity. Nitrofurantoin-induced liver injury and death have been reported. Hepatotoxicity is reversible if recognized early and nitrofurantoin is stopped, so hepatic enzymes should be monitored in women at higher doses or with prolonged use. [42]


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