Asymptomatic bacteriuria in pregnant women: modern concept of antimicrobial therapy

DOI

https://dx.doi.org/10.18565/aig.2026.89

Belyi L.E., Maliavin A.I.
1) Ulyanovsk State University, Ulyanovsk, Russia; 2) ‘Klinikum’ Men’s and Women’s Health Centre, Ulyanovsk, Russia

Asymptomatic bacteriuria (ABU) is the detection of one or more bacterial species isolated from a urine sample at a concentration of ≥105 CFU/ml, regardless of the presence of pyuria, in the absence of signs or symptoms characteristic of a urinary tract infection. ABU in the population of pregnant women requires special attention. Whilst the notion that a healthy person’s urine is sterile has now been disproved, most urological associations continue to recommend screening for and treatment of ABU to reduce the risk of pyelonephritis in pregnant women. This recommendation was formulated some time ago on the basis of research findings from the second half of the last century, which showed that antimicrobial treatment of ABU in pregnant women reduced the incidence of pyelonephritis from 20–35% to 1–4%. In Russia, the recommended treatment for ABU during pregnancy is a standard short course of antibiotics or a single dose of fosfomycin trometamol.
This review analyzes the results of recent clinical studies on antimicrobial therapy for ABU in pregnant women. It discusses issues relating to pregnant women’s adherence to antibacterial treatment for ABU. A comparative analysis was carried out to assess the effectiveness of single-dose therapy with fosfomycin trometamol versus standard short courses of other antimicrobial drugs in the treatment of ABU in pregnant women. The challenges of antibacterial therapy related to the potential teratogenic effects of the antibiotics used are described.
Conclusion. It is necessary to conduct further research to understand the appropriateness of treating ABU in pregnant women, as it will contribute to the rational use of antimicrobials and a reduction in microbial resistance within the population of pregnant women.

Authors’ contributions. Belyi L.E., Maliavin A.I. – developing the concept of the study, collecting and processing the material, writing the text, editing the article.
Conflicts of interest. The authors declare that there are no conflicts of interest.
Funding. The study was conducted without sponsorship.
Generative Artificial Intelligence. No generative artificial intelligence technologies were used in the preparation of this article.
For citation: Belyi L.E., Maliavin A.I. Asymptomatic bacteriuria
in pregnant women: modern concept of antimicrobial therapy.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2026; (8): 5-12 (in Russian)
https://dx.doi.org/10.18565/aig.2026.89

asymptomatic bacteriuria

urine

pregnancy

antibiotic

fosfomycin

nitrofurantoin

compliance

Full text (in Russian)

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Received 16.03.2026

Accepted 09.07.2026

Lev E. Belyi, Dr. Med. Sci., Professor at the Department of Hospital Surgery named after V.I. Midlenko, Ulyanovsk State University, 432017, Russia, Ulyanovsk,
Leo Tolstoy str., 42, +7(917)605-97-19, lbely@yandex.ru, https://orcid.org/0000-0003-0908-1321
Anton I. Maliavin, PhD, urologist, «Klinikum» Men’s and Women’s Health Centre, 432054, Russia, Ulyanovsk, Kamyshinskaya str., 43B, +7(960)372-15-91,
721591@mail.ru, https://orcid.org/0009-0009-8886-3217
Corresponding author: Lev E. Belyi, lbely@yandex.ru

Asymptomatic bacteriuria in pregnant women: modern concept of antimicrobial therapy

Belyi L.E., Maliavin A.I.

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