Pyelonephritis in pregnancy. The role of in-hospital management and nitrofurantoin suppression.
Acute pyelonephritis remains a frequent complication of pregnancy. Prevention of the potential complications of this disease requires aggressive in-hospital management. However, the high frequency of positive outpatient cultures following discharge has cast doubt on the adequacy of in-hospital care and, at the same time, has concentrated attention on follow-up care. In a randomized, prospective study, we evaluated the effects of in-hospital management and outpatient nitrofurantoin on subsequent urine cultures. The overall frequency of positive cultures following discharge from the hospital was 38%. However, appropriate antibiotic selection, a negative follow-up in-hospital culture and nitrofurantoin suppression reduced the rate to 8% (P less than .01). Nitrofurantoin did not reduce the rate of positive cultures if antibiotic selection was inappropriate or if the in-hospital follow-up culture was positive. These results suggest that more aggressive management of acute pyelonephritis in pregnancy may be indicated and that suppressive therapy cannot compensate for inappropriate in-hospital management.
Department of Obstetrics and Gynecology, University of Southern California School of Medicine, Los Angeles.
J P
JP
Van Dorsten
R R
RR
Lenke
B S
BS
Schifrin
D000328:Adult; D004352:Drug Resistance, Microbial; D005260:Female; D006760:Hospitalization; D006801:Humans; D009582:Nitrofurantoin / Q000627:therapeutic use*; D010044:Outpatient Clinics, Hospital; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000628:therapy*; D011446:Prospective Studies; D011704:Pyelonephritis / Q000628:therapy*; D011897:Random Allocation
D009582:Nitrofurantoin