Key points
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Antimicrobial choice in pregnancy should reflect safety for both the mother and the fetus.
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During pregnancy, asymptomatic bacteriuria (ASB) significantly increases the risk of pyelonephritis and subsequent maternal and fetal complications. Treatment of ASB significantly reduces these risks.
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Pregnant patients should be screened for ASB at least once early in pregnancy, and, if culture is positive, treated for 3 to 7 days. These patients should be followed with serial cultures throughout pregnancy, and prophylactic antimicrobial therapy should be considered.
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Pregnant patients with cystitis should also be treated for 3 to 7 days. These patients should be followed with serial cultures throughout pregnancy, and prophylactic antimicrobial therapy should be considered.
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Pregnant patients with pyelonephritis should initially be admitted for intravenous antimicrobial therapy and receive a total of 7 to 14 days of culture-directed treatment. These patients should be followed with serial cultures throughout pregnancy, and prophylactic antimicrobial therapy should be strongly considered.

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