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To compare 3-day vs 7-day antimicrobial treatment for asymptomatic bacteriuria in pregnant women
in a pilot study.
Pregnant women with asymptomatic bacteriuria (100,000 cfu/mL) were randomized to 3-day or 7-day
nitrofurantoin treatment. Exclusion criteria included symptomatic bacteriuria at enrollment, previously treated bacteriuria
in the current pregnancy, underlying renal disorders, antibiotic use within one week prior to initial culture or treatment,
bacterial resistance to nitrofurantoin, or other contraindications to nitrofurantoin. Urine test of cure (TOC) was performed
2-4 weeks after initiation of treatment. Subjects with persistent bacteriuria received an additional 7-day treatment course
with an antimicrobial agent based on uropathogen sensitivities and selected at the physician’s discretion. Following
delivery, antenatal, perinatal, and neonatal data were reviewed. Statistical analyses were performed using t-test, Chisquare,
and Fisher exact where appropriate. Analysis was based on intent-to-treat.
Forty-four of 60 patients had complete prenatal and delivery records. Twenty-four patients (54.5%) were
randomized to 3-day treatment and 20 patients (45.5%) to 7-day treatment. Six (25%) patients in the 3-day group had
persistent bacteriuria at TOC, compared to 2 (10%) patients in the 7-day group (p=0.19). There were no statistical
differences between the groups in maternal age, gestational age at enrollment, mode of delivery, birth weight, NICU
admissions, or the incidence of recurrent urinary tract infections or pyelonephritis.
Based on our small sample group, 3-day nitrofurantoin treatment had statistically comparable outcomes to 7-
day treatment for asymptomatic bacteriuria in pregnant patients, yet 3-day-treated women were 2.5 times more likely to
have persistent bacteriuria than 7-day-treated women. The possibility of a beta error exists. In light of recent data which
indicates that 1-day nitrofurantoin therapy is less effective than 7-day treatment in pregnant women, we recommend 7-day
treatment for ASB.