Urinary tract infections in pregnant women

DOI

https://dx.doi.org/10.18565/aig.2024.175

Shabanova N.E.
Academician V.I. Kulakov National Medical Research Centre for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, Moscow, Russia

Urinary tract infections (UTIs) are among the most common infectious disorders. They are diagnosed in 150 million people each year and are most commonly detected in women. The incidence of UTIs during pregnancy currently ranges from 4 to 47% worldwide. Physiological changes in a woman’s body associated with pregnancy and certain risk factors contribute to the development and spread of UTIs. This review presents the scientific data on a new dosage form which is a dispersible tablet. The pharmacokinetic profile of dispersible forms increases the clinical efficacy and tolerance of the drugs thereby reducing antimicrobial resistance.
Cefixime EXPRESS refers to such drugs; it has a broad spectrum of antimicrobial activity and it affects pathogens with β-lactamase activity. Dispersible tablets have an advantage in pharmacokinetic properties, a favorable safety and efficacy profile in the treatment of uncomplicated UTIs during pregnancy. The drug is well tolerated and convenient to use for both inpatients when used in step therapy, and outpatients, namely women with UTIs; it can also be administered empirically in case of intolerance to first-line drugs.
Conclusion: Cefixime EXPRESS in the form of dispersible tablets is a promising medication for the treatment of uncomplicated UTIs during pregnancy as it shows high efficacy and safety. Administering the medication once a day is convenient and increases patient compliance.

Conflicts of interest: Author declares lack of the possible conflicts of interests.
Funding: The study was conducted without sponsorship.
For citation: Shabanova N.E. Urinary tract infections in pregnant women.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2024; (8): 153-158 (in Russian)
https://dx.doi.org/10.18565/aig.2024.175

urinary tract infections

pregnancy

bacteriuria

Cefixime EXPRESS

antibiotic therapy in pregnancy

Full text (in Russian)

Dirección General de Epidemiología. Boletín Epidemiológico. Sistema Nacional De Vigilancia Epidemiológica. Vol. 34 México, D.F: Sistema Único de Información; 2017.
Ballesteros-Monrreal M.G., Arenas-Hernández M.M., Enciso-Martínez Y., Martínez-de la Peña C.F., Rocha-Gracia R.D.C., Lozano-Zaraín P. et al. Virulence and resistance determinants of uropathogenic Escherichia coli strains isolated from pregnant and non-pregnant women from two states in Mexico. Infect. Drug Resist. 2020; 13: 295-310. https://dx.doi.org/10.2147/IDR.S226215.
Gilbert N.M., O'Brien V.P., Hultgren S., Macones G., Lewis W.G., Lewis A.L. Urinary tract infection as a preventable cause of pregnancy complications: opportunities, challenges, and a global call to action. Glob. Adv. Health Med. 2013; 2(5): 59-69. https://dx.doi.org/10.7453/gahmj.2013.061.
Министерство здравоохранения Российской Федерации. Клинические рекомендации. Инфекции мочевых путей при беременности. 2021. [Ministry of Health of the Russian Federation. Clinical guidelines. Urinary tract infections in pregnancy. 2021. (in Russian)]. https://cr.minzdrav.gov.ru/recomend/719_1
Johnson C.Y., Rocheleau C.M., Howley M.M., Chiu S.K., Arnold K.E., Ailes E.C. Characteristics of women with urinary tract infection in pregnancy. J. Womens Health (Larchmt). 2021; 30(11): 1556-64. https://dx.doi.org/10.1089/jwh.2020.8946.
Jin J., Li C., He Y., Pan J., Zhu J., Tang J. Real world drug treatment models for pregnancy complicated with urinary tract infection in China from 2018 to 2022: a cross-section analysis. Front. Pharmacol. 2024; 15: 1349121. https://dx.doi.org/10.3389/fphar.2024.1349121.
Baraka M.A., AlLehaibi L.H., AlSuwaidan H.N., Alsulaiman D., Islam A., Alotaibi B.S. et al. Patterns of infections and antimicrobial drugs’ prescribing among pregnant women in Saudi Arabia: a cross sectional study. J. Pharm. Policy Pract. 2021; 14(1): 9. https://dx.doi.org/10.1186/s40545-020-00292-6
Belete M.A. Bacterial profile and ESBL screening of urinary tract infection among asymptomatic and symptomatic pregnant women attending antenatal care of Northeastern Ethiopia Region. Infect. Drug Resist. 2020; 13: 2579-92. https://dx.doi.org/10.2147/IDR.S258379.
Martinez de Tejada B. Antibiotic use and misuse during pregnancy and delivery: benefits and risks. Int. J. Environ. Res. Public Health. 2014; 11(8): 7993-8009. https://dx.doi.org/10.3390/ijerph110807993.
Сандакова Е.А., Жуковская И.Г., Семенова М.В., Ваганова А.Ф., Кузнецова А.В., Казымова Т.Е., Белоусова О.А., Макарова Л.П. Фармакотерапия беременных. РМЖ. Мать и дитя. 2021; 4(2): 115-8. [Sandakova E.A., Zhukovskaya I.G., Semenova M.V. et al. Pharmacotherapy in pregnant women. Russian Journal of Woman and Child Health. 2021; 4(2): 115-8. (in Russian)]. https://dx.doi.org/10.32364/2618-8430-2021-4-2-115-118.
Радзинский В.Е., Соловьев А.В., Ипастов И.Д. Концепция минимального вмешательства. Рационализация подхода к назначению лекарственных средств беременным. М.: StatusPraesens; 2018. [Radzinsky V.E., Soloviev A.V., Ipastov I.D. The concept of minimal intervention. Rationalization of the approach to prescribing medicines to pregnant women. Мoscow: StatusPraesens; 2018. (in Russian)].
Grette K., Cassity S., Holliday N., Rimawi B.H. Acute pyelonephritis during pregnancy: a systematic review of the aetiology, timing, and reported adverse perinatal risks during pregnancy. J. Obstet. Gynaecol. 2020; 40(6): 739-48. https://dx.doi.org/10.1080/01443615.2019.1647524.
Тютюнник В.Л., Михайлова О.И., Кан Н.Е., Мирзабекова Д.Д. Бессимптомная бактериурия при беременности: современный подход к терапии. Акушерство и гинекология. 2022; 11: 165-70. [Tyutyunnik V.L., Mikhailova O.I., Kan N.E., Mirzabekova D.D. Asymptomatic bacteriuria in pregnancy: a modern approach to therapy. Obstetrics and Gynecology. 2022; (11): 165-70. (in Russian)]. https://dx.doi.org/10.18565/aig.2022.11.165-170.
Moore A., Doull M., Grad R., Groulx S., Pottie K., Tonelli M. et al.; Canadian Task Force on Preventive Health Care. Recommendations on screening for asymptomatic bacteriuria in pregnancy. CMAJ. 2018; 190(27): E823-E830. https://dx.doi.org/10.1503/cmaj.171325.
Schnarr J., Smaill F. Asymptomatic bacteriuria and symptomatic urinary tract infections in pregnancy. Eur. J. Clin. Invest. 2008; 38 Suppl 2: 50-7. https://dx.doi.org/10.1111/j.1365-2362.2008.02009.x.
Angelescu K., Nussbaumer-Streit B., Sieben W., Scheibler F., Gartlehner G. Benefits and harms of screening for and treatment of asymptomatic bacteriuria in pregnancy: a systematic review. BMC Pregnancy Childbirth. 2016; 16(1): 336. https://dx.doi.org/10.1186/s12884-016-1128-0.
Smaill F. Antibiotics for asymptomatic bacteriuria in pregnancy. Cochrane Database Syst. Rev. 2001; 2: CD000490. https://dx.doi.org/10.1002/14651858.cd000490.
Министерство здравоохранения Российской Федерации. Клинические рекомендации. Нормальная беременность. 2023. [Ministry of Health of the Russian Federation. Clinical guidelines. Normal pregnancy. 2023. (in Russian)]. https://cr.minzdrav.gov.ru/recomend/288
Balachandran L., Jacob L., Al Awadhi R., Yahya L.O., Catroon K.M., Soundararajan L.P. et al. Urinary tract infection in pregnancy and its effects on maternal and perinatal outcome: a retrospective study. Cureus. 2022; 14(1): e21500. https://dx.doi.org/10.7759/cureus.21500.
Taghavi Zahedkalaei A., Kazemi M., Zolfaghari P., Rashidan M., Sohrabi M.B. Association between urinary tract infection in the first trimester and risk of preeclampsia: a case-control study. Int. J. Womens Health. 2020; 12: 521-6. https://dx.doi.org/10.2147/IJWH.S256943.
Smaill F.M., Vazquez J.C. Antibiotics for asymptomatic bacteriuria in pregnancy. Cochrane Database Syst. Rev. 2019; 2019(11): CD000490. https://dx.doi.org/10.1002/14651858.CD000490.pub4.
Goebel M.C., Trautner B.W., Grigoryan L. The five Ds of outpatient antibiotic stewardship for urinary tract infections. Clin. Microbiol. Rev. 2021; 34:e00003-20. https://dx.doi.org/10.1128/CMR.00003-20.
Mohapatra S., Venugopal S.J., Kalaivani M., Kant S., Tak V., Panigrahy R. et al.; CAUTION-ED Study (Community-acquired UTI, Emerging Drug Resistance). Antibiotic resistance of uropathogens among the community-dwelling pregnant and nonpregnant female: a step towards antibiotic stewardship. BMC Infect. Dis. 2022; 22(1): 939. https://dx.doi.org/10.1186/s12879-022-07914-1.
Вёрткин А.Л., Шамуилова М.М., Кнорринг Г.Ю. Особенности и преимущества применения современных форм антибиотиков с улучшенными фармакокинетическими свойствами. Лечащий врач. 2022; 9(25): 61-4. [Vertkin A.L., Shamuilova M.M., Knorring G.Yu. Features and benefits of using new forms of antibiotics with improved pharmacokinetic properties. Lechaschi Vrach. 2022; 9(25): 61-4. (in Russian)]. https://dx.doi.org/10.51793/OS.2022.25.9.011.
Таточенко В.К. Антибиотики в лекарственной форме солютаб. Современная педиатрия. 2012; 2(42): 69-72. [Tatochenko V.K. Antibiotics in solutab dosage form. Modern Pediatrics. 2012; 2(42): 69-72. (in Russian)].
Rimoin A.W., Hoff N.A., Fischer Walker C.L., Hamza H.S., Vince A., Abdel Rahman N. et al. Treatment of streptococcal pharyngitis with once-daily amoxicillin versus intramuscular benzathine penicillin G in low-resource settings: a randomized controlled trial. Clin. Pediatr. (Phila). 2011; 50(6):535-42. https://dx.doi.org/10.1177/0009922810394838.
Государственный реестр лекарственных средств. Доступно по: https://grls.rosminzdrav.ru/GRLS [State Register of Medicines. Available at: https://grls.rosminzdrav.ru/GRLS (in Russian)].
Зырянов С.К. Исследование сравнительной кинетики растворения препаратов цефиксима. Фарматека. 2016; 10: 67-71. [Zyryanov S.K. Comparative evaluation of dissolution kinetics of cefixime preparations. Farmateka. 2016; 10: 67-71. (in Russian)].
Зырянов С.К., Байбулатова Е.А. Использование новых лекарственных форм антибиотиков как путь повышения эффективности и безопасности антибактериальной терапии. Антибиотики и химиотерапия. 2019; 64(3-4): 81-91. [Zyryanov S.K., Baibulatova E.A. The use of new dosage forms of antibiotics as a way to improve the effectiveness and safety of antibiotic therapy. Antibiotics and Chemotherapy. 2019; 64(3-4): 81-91. (in Russian)]. https://dx.doi.org/10.24411/0235-2990-2019-10020.
Яковлев С.В. Новая концепция рационального применения антибиотиков в амбулаторной практике. Антибиотики и химиотерапия. 2019; 64(3-4): 47-57. [Yakovlev S.V. New concept of rational use of antibiotics in outpatient practice. Antibiotics and Chemotherapy. 2019; 64(3-4): 48-58. (in Russian)]. https://dx.doi.org/10.24411/0235-2990-2019-100017.
Орлова Н.В. Антибиотикорезистентность и современная стратегия антибактериальной терапии. Медицинский Совет. 2022; (8): 89-97. [Orlova N.V. Antibiotic resistance and modern strategy of antibacterial therapy. Medical Council. 2022; (8): 89-97. (in Russian)]. https://dx.doi.org/10.21518/2079-701X-2022-16-8-89-97.
https://clinline.ru/reestr-klinicheskih-issledovanij/582-22.11.2018.html
Инструкция по медицинскому применению препарата Цефиксим Экспресс, таблетки диспергируемые. Доступно по: https://grls.minzdrav.gov.ru/Grls [Instructions for medical use of Cefixime Express dispersible tablets. Available at: https://grls.minzdrav.gov.ru/Grls (in Russian)].
Кузьменко А.В., Кузьменко В.В., Гяургиев Т.А. Место цефалоспоринов в терапии инфекции нижних мочевыводящих путей. РМЖ. Медицинское обозрение. 2023; 7(4): 212-7. [Kuzmenko A.V., Kuzmenko V.V., Gyaurgiev T.A. The place of cephalosporins in the treatment of lower urinary tract infection. Russian Medical Inquiry. 2023; 7(4): 212-7 (in Russian)]. https://dx.doi.org/10.32364/2587-6821-2023-7-4-212-217.
Власова И. Пациенты предпочитают однократный прием антибиотков. Фармацевтический вестник. 2007. Доступно по: https://pharmvestnik.ru/content/news/4036.html [Vlasova I. Patients prefer a single dose of antibiotics. Pharmatsevticheskiy Vestnik. 2007. Available at: https://pharmvestnik.ru/content/news/4036.html (in Russian)].
Kardas P. Comparison of patient compliance with once–daily and twice–daily antibiotic regimens in respiratory tract infections: results of a randomized trial. J. Antimicrob. Chemother. 2007; 59(3): 531-6. https://dx.doi.org/10.1093/jac/dkl528.
Pechère J.C., Hughes D., Kardas P., Cornaglia G. Non-compliance with antibiotic therapy for acute community infections: a global survey. Int. J. Antimicrob. Agents. 2007; 29(3): 245-53. https://dx.doi.org/10.1016j.ijantimicag.2006.09.026.
https://www.e-lactancia.org/breastfeeding/tsefiksim/writing/
Рафальский В.В., Довгань Е.В., Козырев Ю.В., Густоварова Т.А., Хлыбова С.В., Новоселова А.В., Филиппенко Н.Г., Лихих Д.Г. Эффективность и безопасность цефиксима и амоксициллина/клавуланата при лечении бессимптомной бактериурии у беременных женщин: рандомизированное проспективное многоцентровое исследование. Урология. 2013; (5): 24-8. [Rafal'skiĭ V.V., Dovgan' E.V., Kozyrev Iu.V., Gustovarova T.A., Khlybova S.V., Novoselova A.V., Filippenko N.G., Likhikh D.G. The efficacy and safety of cefixime and amoxicillin/clavulanate in the treatment of asymptomatic bacteriuria in pregnant women: a randomized, prospective, multicenter study. Urologiia. 2013; (5): 24-8. (in Russian)].
Bader M.S., Loeb M., Leto D., Brooks A.A. Treatment of urinary tract infections in the era of antimicrobial resistance and new antimicrobial agents. Postgrad. Med. 2020; 132(3): 234-50. https://dx.doi.org/10.1080/00325481.2019.1680052.
Гаджиева З.К., Гомберг М.А., Григорян В.А., Газимиев М.А., Казилов Ю.Б. Особенности диагностики и лечения беременных женщин с неосложненной инфекцией мочевыводящих путей и урогенитальными инфекциями. Акушерство и гинекология. 2018; 11: 146-51. [Gadzhieva Z.K., Gomberg M.A., Grigoryan V.A., Gazimiev M.A., Kazilov Yu.B. Specific features of diagnosis and treatment in pregnant women with uncomplicated urinary tract infection and urogenital infections. Obstetrics and Gynecology. 2018; (11): 146-51. (in Russian)]. https://dx.doi.org/10.18565/aig.2018.11.146-151.

Received 10.07.2024

Accepted 01.08.2024

Natalia E. Shabanova, PhD, Associate Professor, Head of the Unit of Clinical Pharmacology, Institute of Microbiology, Antimicrobial Therapy and Epidemiology, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, 117997, Russia, Moscow, Ac. Oparin str., 4, +7(985)097-58-27, n_shabanova@oparina4.ru, https://orcid.org/0000-0001-6838-3616

Urinary tract infections in pregnant women

Shabanova N.E.

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