# Asymptomatic Bacteriuria (Pregnancy) - Category: infectious - Review status: reviewed (every claim checked against a document named on this page) - Sources: Egyptian National Drug Formulary - Antimicrobial 2023 · Monuril 3g granules for oral solution SmPC sections 4.1-4.2 (eMC product 7329) · UTI and asymptomatic bacteriuria in pregnancy - disease-level clinical article (uti-in-pregnancy-full.txt) - Verified date: 2026-08 ## Verified against - Egyptian National Drug Formulary - Antimicrobial 2023 - Monuril 3g granules for oral solution SmPC sections 4.1-4.2 (eMC product 7329) - UTI and asymptomatic bacteriuria in pregnancy - disease-level clinical article (uti-in-pregnancy-full.txt) ## Treatment metadata - Nitrofurantoin — 100 mg — oral.solid - Amoxicillin + Clavulanic acid — 625 mg — oral.solid - Fosfomycin — 3000 mg — oral.solid ## Complete treatment card ```text ASYMPTOMATIC BACTERIURIA (PREGNANCY) Sources: Egyptian National Drug Formulary - Antimicrobial 2023 · Monuril 3g granules for oral solution SmPC sections 4.1-4.2 (eMC product 7329) · UTI and asymptomatic bacteriuria in pregnancy - disease-level clinical article (uti-in-pregnancy-full.txt) Review status: REVIEWED against 3 sources listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (1) - By definition, no urinary symptoms are present despite bacteria in the urine TESTS (7) - Diagnosis requires a urine culture, either clean-catch or catheter specimen - In women, two consecutive clean-catch specimens with the same organism at 100,000 CFU/mL or more confirm the diagnosis - In men, one clean-catch specimen with a single organism at 100,000 CFU/mL or more is diagnostic - A catheterized specimen needs only 100 CFU/mL or more of a single organism to confirm the diagnosis - Leukocyte esterase on dipstick detects pyuria reliably but is not specific for bacteriuria - Combining leukocyte esterase and nitrite dipstick testing is more specific than either alone - Pregnant women should be screened with a urine culture around the end of the first trimester IF NOT THIS - what else fits (6) - Acute pyelonephritis as the true diagnosis - Chlamydial genitourinary infection - Nonbacterial cystitis - Interstitial cystitis - Pelvic inflammatory disease - A renal or perirenal abscess Source StatPearls "Asymptomatic Bacteriuria" - disease-level clinical article Status traced to the source above 1. NITROFURANTOIN [1st line] Adult 100 mg twice daily (modified-release) for 7 days in pregnant women with positive screening urine culture x 7 days Peds Adult-only condition - paediatric section not applicable Choice Alternatives. Nitrofurantoin is the narrow-spectrum first-line agent for bacteriuria in pregnancy; co-amoxiclav is kept as the broader alternative. Avoid nitrofurantoin at term. Source Egyptian National Drug Formulary - Antimicrobial 2023 Why Urinary antiseptic that concentrates in the urine to clear asymptomatic bacteriuria in pregnancy; treating it matters because, left alone, it raises the risk of pyelonephritis and preterm labor. Avoided close to delivery for the reason already noted in the cautions. Caution Screening and treating asymptomatic bacteriuria is indicated ONLY in PREGNANT WOMEN and prior to traumatic urological procedures. CONTRAINDICATED at term (36-42 weeks pregnancy) due to risk of neonatal hemolytic anemia. Avoid in renal impairment (eGFR <45 mL/min). Egypt COLIFURAN 100 MG 20 TABS. KAHIRA 2.40 EGP (0.12/unit) UVAMINE RETARD 100 MG 20 CAPS. MUP > ACINO 47.00 EGP (2.35/unit) MEPAFURAN 100 MG 20 CAPS. MEPACO 54.00 EGP (2.70/unit) MACROFURAN 100 MG 30 CAPS. KAHIRA 82.00 EGP (2.73/unit) 2. AMOXICILLIN + CLAVULANIC ACID [1st line] Adult 500/125 mg three times daily (or 875/125 mg twice daily) x 7 days Peds Adult-only condition - paediatric section not applicable Source Egyptian National Drug Formulary - Antimicrobial 2023 Why Broad-spectrum penicillin and beta-lactamase inhibitor combination used as an alternative to nitrofurantoin for asymptomatic bacteriuria in pregnancy, chosen when nitrofurantoin is unsuitable or culture sensitivities favor it; the formulary rates it Pregnancy Risk Factor B. Caution The Egyptian formulary rates it Pregnancy Risk Factor B and says nothing about individual trimesters. On breastfeeding it is specific: amoxicillin/clavulanate may be used while breastfeeding, with care, at the doses usually recommended, and the infant watched for gastrointestinal upset - thrush and diarrhoea in particular. Check urine culture sensitivity results. Egypt AUJED 625 MG 12 F.C. TAB. SIGMA TEC > J... 19.20 EGP (1.60/unit) E-MOXCLAV 625MG 10 TAB. EIPICO 30.00 EGP (3.00/unit) DEXICLAVE 625 MG 12 F.C. TABS. RAMEDA > NOVE... 37.50 EGP (3.12/unit) MAGNABIOTIC 625MG 8 TAB. SEDICO 37.00 EGP (4.62/unit) CLAVIMOX 625 MG 12 F.C.TABS. PHARCO 107.00 EGP (8.92/unit) CURAM 625MG 12 F.C.TAB. SANDOZ > NOVA... 108.00 EGP (9.00/unit) AUGMENTIN 625 MG 10 F.C.TABS. MUP > SMITHKL... 117.00 EGP (11.70/unit) CLAVOCILLIN 625 MG 10 DISPERSIBLE TABS. RAMEDA > ORGANOPHARMA 31.50 EGP LARYNCLAVE 125/31 PD. FOR ORAL SUSP. 70ML MISR > AL ROWAD PHARMACEUTICAL... 8.00 EGP -> ? strength differs, ? different route - not oral solid MEGACLAVOX 156MG/5ML PD. FOR SUSP. 60 ML CID 8.00 EGP -> ? strength differs, ? different route - not oral solid 3. FOSFOMYCIN [2nd line] Adult Fosfomycin 3 g orally once. Dissolve the sachet in a glass of water and take it immediately, on an empty stomach - about 2-3 hours before or after a meal - preferably before bedtime and after emptying the bladder. - single dose Peds Adult-only condition - paediatric section not applicable Source UTI and asymptomatic bacteriuria in pregnancy - disease-level clinical article (uti-in- pregnancy-full.txt) Why Urinary antiseptic valued in pregnancy for how simple the course is to complete, making it a useful alternative to nitrofurantoin or amoxicillin-clavulanate when finishing a longer antibiotic course is a concern. Caution The Monuril label's own indications are acute uncomplicated cystitis and prostate-biopsy prophylaxis; it does not name asymptomatic bacteriuria. The indication and the 3 g single dose come from the pregnancy UTI article, and the label supplies only how to take the sachet. Not recommended by the label in renal impairment with creatinine clearance below 10 ml/min. Fosfomycin is a reasonable option for asymptomatic bacteriuria, though it may be less effective for cystitis than a multi-day regimen. The label does not say it is safe in pregnancy - it says Monuril "should only be used during pregnancy, if clearly necessary" (