What is the first-line treatment for urinary tract infections during pregnancy?

• A. Nitrofurantoin
• B. Ciprofloxacin
• C. Bactrim
• D. None, typically pregnant women are asymptomatic

Answer: (A)

In pregnancy, choose an antibiotic that is effective against common urinary pathogens but has a favorable safety profile for the fetus. Nitrofurantoin fits this need and is used as the first-line treatment for cystitis during pregnancy because it achieves high concentrations in the urine and has a long history of safe use in this population when not used near delivery. In contrast, fluoroquinolones like ciprofloxacin are avoided in pregnancy due to potential fetal harm to developing cartilage. Trimethoprim-sulfamethoxazole is also avoided, especially in the first trimester and late in pregnancy, because of teratogenic risks and neonatal complications such as hyperbilirubinemia. Therefore, nitrofurantoin is the best answer.