Q: I am a 27 years old female in my 12th week of pregnancy. I have a urinary tract infection (UTI) with over 100 pus cells / hpf. The culture & sensitivity test showed the bacteria to be E. coli with a colony count of more than 100,000 / ml (pathogenic bacteria). The bacteria were only sensitive to flouroquinolones, which I can't take due to pregnancy and to cefalosporins (ceftriaxone, ceftazidime and cefepime) and resistant to all other antibiotics. I have taken ceftriaxone IM (1 g) for five days but there is no improvement. My urine still smells so foul. What amount of dosage of ceftriaxone should be taken? Is it safe to take ceftriaxone during pregnancy?

A:The rationale for treating urinary tract infection in asymptomatic pregnant female (i.e. even without any the urinary symptoms but positive urine culture) is to decrease the incidence of acute pyelonephritis (infections in the kidneys) and its possible adverse impact on the pregnancy and fetus.

Among the available antibiotics, the aminopenicillins (Ampicillin, Amoxycillin etc.) and cephalosporins are generally considered safe and effective throughout pregnancy. Given the low efficacy of short-course ß-lactam therapy in non-pregnant women, it is prudent to take a 7-10 day course of therapy in pregnant women. Follow-up cultures (after 48 hours of cessation of antibiotic therapy) should be obtained to document absence of infection. If the culture is positive, the cause of bacteriuria must be determined to assess lack of resolution, bacterial persistence, or reinfection. If the infection is unresolved, proper selection (urine culture based therapy) and administration of another drug probably will solve the problem. If the problem is bacterial persistence or rapid reinfection, antimicrobial suppression of infection or prophylaxis throughout the remainder of the pregnancy should be considered.

I believe you have already undergone an ultrasonography of the kidney ureter and bladder region to rule out any predisposing cause of UTI.