What is the recommended antibiotic prophylaxis for recurrent UTIs during pregnancy?

For recurrent urinary tract infections (UTIs) during pregnancy, the recommended antibiotic prophylaxis is nitrofurantoin, commonly known by the brand name Macrobid. Administering 100 mg of Macrobid nightly is effective in preventing recurrent infections due to its antibacterial properties and its low risk of causing complications for both the pregnant patient and the fetus.

Nitrofurantoin is generally considered safe for use during pregnancy, particularly in the first and second trimesters, making it preferable for women who require ongoing prophylaxis against UTIs. Its mechanism involves inhibiting bacterial cell wall synthesis and is particularly effective against the common uropathogens associated with UTIs.

In contrast, other antibiotics listed might not be the optimal choice for prophylaxis in pregnancy. Cephalexin is generally safe but may not have the same level of evidence supporting its use specifically for recurrent UTIs as nitrofurantoin. Ampicillin can be used, but it is typically not the first choice for prophylaxis. Ciprofloxacin, a fluoroquinolone, is contraindicated during pregnancy due to potential adverse effects on fetal development. Thus, nightly use of Macrobid aligns with both safety and efficacy in managing recurrent UTIs in pregnant women.