Diagnosis and treatment of urinary tract infections across age groups

Published:January 02, 2018DOI:
      Urinary tract infections are the most common outpatient infections, but predicting the probability of urinary tract infections through symptoms and test results can be complex. The most diagnostic symptoms of urinary tract infections include change in frequency, dysuria, urgency, and presence or absence of vaginal discharge, but urinary tract infections may present differently in older women. Dipstick urinalysis is popular for its availability and usefulness, but results must be interpreted in context of the patient’s pretest probability based on symptoms and characteristics. In patients with a high probability of urinary tract infection based on symptoms, negative dipstick urinalysis does not rule out urinary tract infection. Nitrites are likely more sensitive and specific than other dipstick components for urinary tract infection, particularly in the elderly. Positive dipstick testing is likely specific for asymptomatic bacteriuria in pregnancy, but urine culture is still the test of choice. Microscopic urinalysis is likely comparable to dipstick urinalysis as a screening test. Bacteriuria is more specific and sensitive than pyuria for detecting urinary tract infection, even in older women and during pregnancy. Pyuria is commonly found in the absence of infection, particularly in older adults with lower urinary tract symptoms such as incontinence. Positive testing may increase the probability of urinary tract infection, but initiation of treatment should take into account risk of urinary tract infection based on symptoms as well. In cases in which the probability of urinary tract infection is moderate or unclear, urine culture should be performed. Urine culture is the gold standard for detection of urinary tract infection. However, asymptomatic bacteriuria is common, particularly in older women, and should not be treated with antibiotics. Conversely, in symptomatic women, even growth as low as 102 colony-forming unit/mL could reflect infection. Resistance is increasing to fluoroquinolones, beta-lactams, and trimethoprim-sulfamethoxazole. Most uropathogens still display good sensitivity to nitrofurantoin. First-line treatments for urinary tract infection include nitrofurantoin, fosfomycin, and trimethoprim-sulfamethoxazole (when resistance levels are <20%). These antibiotics have minimal collateral damage and resistance. In pregnancy, beta-lactams, nitrofurantoin, fosfomycin, and trimethoprim-sulfamethoxazole can be appropriate treatments. Interpreting the probability of urinary tract infection based on symptoms and testing allows for greater accuracy in diagnosis of urinary tract infection, decreasing overtreatment and encouraging antimicrobial stewardship.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Obstetrics & Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Schappert S.M.
        • Rechtsteiner E.A.
        Ambulatory medical care utilization estimates for 2007.
        Vital Health Stat. 2011; 169: 1-38
        • Foxman B.
        Epidemiology of urinary tract infections: incidence, morbidity, and economic costs.
        Am J Med. 2002; 113: 5-13S
        • Flores-Mireles A.L.
        • Walker J.N.
        • Caparon M.
        • Hultgren S.J.
        Urinary tract infections: epidemiology, mechanisms of infection and treatment options.
        Nat Rev Microbiol. 2015; 13: 269-284
        • Frick A.C.
        Lower urinary tract infection.
        in: Walters M.D. Karram M.M. Urogynecology and reconstructive pelvic surgery. 4th ed. Saunders, an imprint of Elsevier Inc, Philadelphia (PA)2015
        • Hooton T.M.
        Clinical practice. Uncomplicated urinary tract infection.
        N Engl J Med. 2012; 366: 1028-1037
        • Rowe T.A.
        • Juthani-Mehta M.
        Urinary tract infection in older adults.
        Aging Health. 2013; 9
        • Foxman B.
        • Barlow R.
        • D'Arcy H.
        • Gillespie B.
        • Sobel J.D.
        Urinary tract infection: self-reported incidence and associated costs.
        Ann Epidemiol. 2000; 10: 509-515
        • Albert X.
        • Huertas I.
        • Pereiró I.I.
        • Sanfélix J.
        • Gosalbes V.
        • Perrota C.
        Antibiotics for preventing recurrent urinary tract infection in non-pregnant women.
        Cochrane Database Syst Rev. 2004; 3CD001209
        • Glaser A.P.
        • Schaeffer A.J.
        Urinary tract infection and bacteriuria in pregnancy.
        Urol Clin North Am. 2015; 42: 547-560
        • American College of Obstetricians and Gynecologists
        Treatment of urinary tract infections in nonpregnant women. ACOG Practice bulletin no. 91.
        Obstet Gynecol. 2008; 111: 785-794
        • Bent S.
        • Nallamothu B.K.
        • Simel D.L.
        • Fihn S.D.
        • Saint S.
        Does this woman have an acute uncomplicated urinary tract infection?.
        JAMA. 2002; 287: 2701-2710
        • Giesen L.G.
        • Cousins G.
        • Dimitrov B.D.
        • van de Laar F.A.
        • Fahey T.
        Predicting acute uncomplicated urinary tract infection in women: a systematic review of the diagnostic accuracy of symptoms and signs.
        BMC Fam Pract. 2010; 11: 78
        • Medina-Bombardó D.
        • Jover-Palmer A.
        Does clinical examination aid in the diagnosis of urinary tract infections in women? A systematic review and meta-analysis.
        BMC Fam Pract. 2011; 12: 111
        • Little P.
        • Turner S.
        • Rumsby K.
        • et al.
        Validating the prediction of lower urinary tract infection in primary care: sensitivity and specificity of urinary dipsticks and clinical scores in women.
        Br J Gen Pract. 2010; 60: 495-500
        • Woodford H.J.
        • George J.
        Diagnosis and management of urinary tract infection in hospitalized older people.
        J Am Geriatr Soc. 2009; 57: 107-114
        • Arinzon Z.
        • Shabat S.
        • Peisakh A.
        • Berner Y.
        Clinical presentation of urinary tract infection (UTI) differs with aging in women.
        Arch Gerontol Geriatr. 2012; 55: 145-147
        • Juthani-Mehta M.
        • Quagliarello V.
        • Perrelli E.
        • Towle V.
        • Van Ness P.H.
        • Tinetti M.
        Clinical features to identify urinary tract infection in nursing home residents: a cohort study.
        J Am Geriatr Soc. 2009; 57: 963-970
        • Jido T.A.
        Urinary tract infections in pregnancy: evaluation of diagnostic framework.
        Saudi J Kidney Dis Transpl. 2014; 25: 85-90
        • FitzGerald M.P.
        • Graziano S.
        Anatomic and functional changes of the lower urinary tract during pregnancy.
        Urol Clin North Am. 2007; 34: 7-12
        • Stanton S.L.
        • Kerr-Wilson R.
        • Harris G.V.
        The incidence of urological symptoms in normal pregnancy.
        Br J Obstet Gynaecol. 1980; 87: 897-900
        • Francis W.J.A.
        Disturbances of bladder function in relation to pregnancy.
        J Obstet Gynaecol Br Empire. 1961; 67: 353-365
        • Aslan D.
        • Aslan G.
        • Yamazhan M.
        • Ispahi C.
        • Tinar S.
        Voiding symptoms in pregnancy: an assessment with international prostate symptom score.
        Gynecol Obstet Invest. 2003; 55: 46-49
        • Simerville J.A.
        • Maxted W.C.
        • Pahira J.J.
        Urinalysis: a comprehensive review.
        Am Fam Physician. 2005; 71 ([erratum in: Am Fam Physician 2006;74:1096]): 1153-1162
        • Meister L.
        • Morley E.J.
        • Scheer D.
        • Sinert R.
        History and physical examination plus laboratory testing for the diagnosis of adult female urinary tract infection.
        Acad Emerg Med. 2013; 20: 631-645
        • Ducharme J.
        • Neilson S.
        • Ginn J.L.
        Can urine cultures and reagent test strips be used to diagnose urinary tract infection in elderly emergency department patients without focal urinary symptoms?.
        CJEM. 2007; 9: 87-92
        • Deville W.L.
        • Yzermans J.C.
        • van Duijn N.P.
        • Bezemer P.D.
        • van der Windt D.A.
        • Bouter L.M.
        The urine dipstick test useful to rule out infections. A meta-analysis of the accuracy.
        BMC Urol. 2004; 4: 4
        • Juthani-Mehta M.
        • Tinetti M.
        • Perrelli E.
        • Towle V.
        • Quagliarello V.
        Role of dipstick testing in the evaluation of urinary tract infection in nursing home residents.
        Infect Control Hosp Epidemiol. 2007; 28: 889-891
        • Khasriya R.
        • Khan S.
        • Lunawat R.
        • et al.
        The inadequacy of urinary dipstick and microscopy as surrogate markers of urinary tract infection in urological outpatients with lower urinary tract symptoms without acute frequency and dysuria.
        J Urol. 2010; 183: 1843-1847
        • Turner L.C.
        • Beigi R.
        • Shepherd J.P.
        • Lowder J.L.
        Utility of dipstick urinalysis in peri- and postmenopausal women with irritative bladder symptoms.
        Int Urogynecol J. 2014; 25: 493-497
        • Rogozińska E.
        • Formina S.
        • Zamora J.
        • Mignini L.
        • Khan K.S.
        Accuracy of onsite tests to detect asymptomatic bacteriuria in pregnancy: a systematic review and meta-analysis.
        Obstet Gynecol. 2016; 128: 495-503
        • Kayalp D.
        • Dogan K.
        • Ceylan G.
        • Senes M.
        • Yucel D.
        Can routine automated urinalysis reduce culture requests?.
        Clin Biochem. 2013; 46: 1285-1289
        • Lammers R.L.
        • Gibson S.
        • Kovacs D.
        • Sears W.
        • Strachan G.
        Comparison of test characteristics of urine dipstick and urinalysis at various test cutoff points.
        Ann Emerg Med. 2001; 38: 505-512
        • Stamm W.E.
        Measurement of pyuria and its relation to bacteriuria.
        Am J Med. 1983; 75: 53-58
        • Leman P.
        Validity of urinalysis and microscopy for detecting urinary tract infection in the emergency department.
        Eur J Emerg Med. 2002; 9: 141-147
        • Boscia J.A.
        • Kobasa W.D.
        • Abrutyn E.
        • Levison M.E.
        • Kaplan A.M.
        • Kaye D.
        Lack of association between bacteriuria and symptoms in the elderly.
        Am J Med. 1986; 81: 979-982
        • Nicolle L.E.
        • Bradley S.
        • Colgan R.
        • Rice J.C.
        • Schaeffer A.
        • Hooton T.M.
        • Infectious Diseases Society of America; American Society of Nephrology; American Geriatric Society
        Infectious Diseases Society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults.
        Clin Infect Dis. 2005; 40 ([erratum in: Clin Infect Dis 2005;40:1556]): 643-654
        • Kupelian A.S.
        • Horsley H.
        • Khasriya R.
        • et al.
        Discrediting microscopic pyuria and leucocyte esterase as diagnostic surrogates for infection in patients with lower urinary tract symptoms: results from a clinical and laboratory evaluation.
        BJU Int. 2013; 112: 231-238
        • Ouslander J.G.
        • Schapira M.
        • Schnelle J.F.
        • Fingold S.
        Pyuria among chronically incontinent but otherwise asymptomatic nursing home residents.
        J Am Geriatr Soc. 1996; 44: 420-423
        • Bachman J.W.
        • Heise R.H.
        • Naessens J.M.
        • Timmerman M.G.
        A study of various tests to detect asymptomatic urinary tract infections in an obstetric population.
        JAMA. 1993; 270: 1971-1974
        • LaRocco M.T.
        • Franek J.
        • Leibach E.K.
        • et al.
        Effectiveness of preanalytic practices on contamination and diagnostic accuracy of urine cultures: a laboratory medicine best practices systematic review and meta-analysis.
        Clin Microbiol Rev. 2016; 29: 105-147
        • Orenstein R.
        • Wong E.S.
        Urinary tract infections in adults.
        Am Fam Physician. 1999; 59 (1237): 1225-1234
        • Stamm W.E.
        • Counts G.W.
        • Running K.R.
        • Fihn S.
        • Turck M.
        • Holmes K.K.
        Diagnosis of coliform infection in acutely dysuric women.
        N Engl J Med. 1982; 307: 463-468
        • Hooton T.M.
        • Roberts P.L.
        • Cox M.E.
        • Stapleton A.E.
        Voided midstream urine culture and acute cystitis in premenopausal women.
        N Engl J Med. 2013; 369: 1883-1891
        • Kaye D.
        • Boscia J.A.
        • Abrutyn E.
        • Levison M.E.
        Asymptomatic bacteriuria in the elderly.
        Trans Am Clin Climatol Assoc. 1989; 100: 155-162
        • Monane M.
        • Gurwitz J.H.
        • Lipsitz L.A.
        • Glynn R.J.
        • Choodnovskiy I.
        • Avorn J.
        Epidemiologic and diagnostic aspects of bacteriuria: a longitudinal study in older women.
        J Am Geriatr Soc. 1995; 43: 618-622
        • Eriksson A.
        • Giske C.G.
        • Ternhag A.
        The relative importance of Staphylococcus saprophyticus as a urinary tract pathogen: distribution of bacteria among urinary samples analyzed during 1 year at a major Swedish laboratory.
        APMIS. 2013; 121: 72-78
        • Magliano E.
        • Grazioli V.
        • Deflorio L.
        • et al.
        Gender and age-dependent etiology of community-acquired urinary tract infections.
        Sci World J. 2012; 2012: 349597
        • Hill J.B.
        • Sheffield J.S.
        • McIntire D.D.
        • Wendel Jr., G.D.
        Acute pyelonephritis in pregnancy.
        Obstet Gynecol. 2005; 105: 18-23
        • McDowall D.R.
        • Buchanan J.D.
        • Fairley K.F.
        • Gilbert G.L.
        Anaerobic and other fastidious microorganisms in asymptomatic bacteriuria in pregnant women.
        J Infect Dis. 1981; 144: 114-122
        • Hextall A.
        • Hooper R.
        • Cardozo L.
        • Stringer C.
        • Workman R.
        Does the menopause influence the risk of bacteriuria?.
        Int Urogynecol J Pelvic Floor Dysfunct. 2001; 12: 332-336
        • Farajnia S.
        • Alikhani M.Y.
        • Ghotaslou R.
        • Naghili B.
        • Nakhlband A.
        Causative agents and antimicrobial susceptibilities of urinary tract infections in the northwest of Iran.
        Int J Infect Dis. 2009; 13: 140-144
        • Kahlmeter G.
        Prevalence and antimicrobial susceptibility of pathogens in uncomplicated cystitis in Europe. The ECO.SENS study.
        Int J Antimicrob Agents. 2003; 22: 49-52
        • Gupta K.
        • Trautner B.
        In the clinic. Urinary tract infection.
        Ann Intern Med. 2012; 156: ITC3-ITC15
        • Lob S.H.
        • Nicolle L.E.
        • Hoban D.J.
        • Kazmierczak K.M.
        • Badal R.E.
        • Sahm D.F.
        Susceptibility patterns and ESBL rates of Escherichia coli from urinary tract infections in Canada and the United States, SMART 2010-2014.
        Diagn Microbiol Infect Dis. 2016; 85: 459-465
        • Zhanel G.G.
        • Hisanaga T.L.
        • Laing N.M.
        • et al.
        • NAUTICA Group
        Antibiotic resistance in outpatient urinary isolates.
        Int J Antimicrob Agents. 2005; 26: 380-388
        • Puerto A.S.
        • Fernández J.G.
        • del Castillo Jde D.
        • Pino M.J.
        • Angulo G.P.
        In vitro activity of beta-lactam and non-beta-lactam antibiotics in extended-spectrum beta-lactamase-producing clinical isolates of Escherichia coli.
        Diagn Microbiol Infect Dis. 2006; 54: 135-139
        • Swami S.K.
        • Liesinger J.T.
        • Shah N.
        • Baddour L.M.
        • Banerjee R.
        Incidence of antibiotic-resistant Escherichia coli bacteriuria according to age and location of onset.
        Mayo Clin Proc. 2012; 87: 753-759
        • Rizvi M.
        • Khan F.
        • Shukla I.
        • Malik A.
        Shaheen. Rising prevalence of antimicrobial resistance in urinary tract infections during pregnancy: necessity for exploring newer treatment options.
        J Lab Physicians. 2011; 3: 98-103
        • Grover M.L.
        • Bracamonte J.D.
        • Kanodia A.K.
        • et al.
        Assessing adherence to evidence-based guidelines for the diagnosis and management of uncomplicated urinary tract infection.
        Mayo Clin Proc. 2007; 82: 181-185
        • Kahan N.R.
        • Chinitz D.P.
        • Kahan E.
        Longer than recommended empiric antibiotic treatment of urinary tract infection in women: an avoidable waste of money.
        J Clin Pharm Ther. 2004; 29: 59-63
        • Gupta K.
        • Hooton T.M.
        • Naber K.G.
        • et al.
        • Infectious Diseases Society of America; European Society for Microbiology and Infectious Diseases
        International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: a 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases.
        Clin Infect Dis. 2011; 52: e103-e120
        • Gupta K.
        • Hooton T.M.
        • Roberts P.L.
        • Stamm W.E.
        Short-course nitrofurantoin for the treatment of acute uncomplicated cystitis in women.
        Arch Intern Med. 2007; 167: 2207-2212
        • Iravani A.
        • Klimberg I.
        • Briefer C.
        • Munera C.
        • Kowalsky S.F.
        • Echols R.M.
        A trial comparing low-dose, short-course ciprofloxacin and standard 7 day therapy with co-trimoxazole or nitrofurantoin in the treatment of uncomplicated urinary tract infection.
        J Antimicrob Chemother. 1999; 43: 67-75
        • Stein G.E.
        Comparison of single-dose fosfomycin and a 7-day course of nitrofurantoin in female patients with uncomplicated urinary tract infection.
        Clin Ther. 1999; 21: 1864-1872
        • McKinnell J.A.
        • Stollenwerk N.S.
        • Jung C.W.
        • Miller L.G.
        Nitrofurantoin compares favorably to recommended agents as empirical treatment of uncomplicated urinary tract infections in a decision and cost analysis.
        Mayo Clin Proc. 2011; 86: 480-488
        • Huttner A.
        • Verhaegh E.M.
        • Harbarth S.
        • Muller A.E.
        • Theuretzbacher U.
        • Mouton J.W.
        Nitrofurantoin revisited: a systematic review and meta-analysis of controlled trials.
        J Antimicrob Chemother. 2015; 70: 2456-2464
        • Arredondo-García J.L.
        • Figueroa-Damián R.
        • Rosas A.
        • et al.
        • uUTI Latin American Study Group
        Comparison of short-term treatment regimen of ciprofloxacin versus long-term treatment regimens of trimethoprim/sulfamethoxazole or norfloxacin for uncomplicated lower urinary tract infections: a randomized, multicenter, open-label, prospective study.
        J Antimicrob Chemother. 2004; 54: 840-843
        • Kavatha D.
        • Giamarellou H.
        • Alexiou Z.
        • et al.
        Cefpodoxime-proxetil versus trimethoprim-sulfamethoxazole for short-term therapy of uncomplicated acute cystitis in women.
        Antimicrob Agents Chemother. 2003; 47: 897-900
        • Vogel T.
        • Verreault R.
        • Gourdeau M.
        • Morin M.
        • Grenier-Gosselin L.
        • Rochette L.
        Optimal duration of antibiotic therapy for uncomplicated urinary tract infection in older women: a double-blind randomized controlled trial.
        CMAJ. 2004; 170: 469-473
        • Henry Jr., D.C.
        • Bettis R.B.
        • Riffer E.
        • et al.
        Comparison of once-daily extended-release ciprofloxacin and conventional twice-daily ciprofloxacin for the treatment of uncomplicated urinary tract infection in women.
        Clin Ther. 2002; 24: 2088-2104
        • Fourcroy J.L.
        • Berner B.
        • Chiang Y.K.
        • Cramer M.
        • Rowe L.
        • Shore N.
        Efficacy and safety of a novel once-daily extended-release ciprofloxacin tablet formulation for treatment of uncomplicated urinary tract infection in women.
        Antimicrob Agents Chemother. 2005; 49: 4137-4143
        • Richard G.A.
        • Mathew C.P.
        • Kirstein J.M.
        • Orchard D.
        • Yang J.Y.
        Single-dose fluoroquinolone therapy of acute uncomplicated urinary tract infection in women: results from a randomized, double-blind, multicenter trial comparing single-dose to 3-day fluoroquinolone regimens.
        Urology. 2002; 59: 334-339
        • Henry D.
        • Ellison W.
        • Sullivan J.
        • et al.
        Treatment of community-acquired acute uncomplicated urinary tract infection with sparfloxacin versus ofloxacin. The Sparfloxacin Multi Center UUTI Study Group.
        Antimicrob Agents Chemother. 1998; 42: 2262-2266
        • Hooton T.M.
        • Scholes D.
        • Gupta K.
        • Stapleton A.E.
        • Roberts P.L.
        • Stamm W.E.
        Amoxicillin-clavulanate vs ciprofloxacin for the treatment of uncomplicated cystitis in women: a randomized trial.
        JAMA. 2005; 293: 949-955
        • Auquer F.
        • Cordón F.
        • Gorina E.
        • Caballero J.C.
        • Adalid C.
        • Batlle J.
        • Urinary Tract Infection Study Group
        Single-dose ciprofloxacin versus 3 days of norfloxacin in uncomplicated urinary tract infections in women.
        Clin Microbiol Infect. 2002; 8: 50-54
        • Nicolle L.E.
        • Madsen K.S.
        • Debeeck G.O.
        • et al.
        Three days of pivmecillinam or norfloxacin for treatment of acute uncomplicated urinary infection in women.
        Scand J Infect Dis. 2002; 34: 487-492
        • Leigh A.P.
        • Nemeth M.A.
        • Keyserling C.H.
        • Hotary L.H.
        • Tack K.J.
        Cefdinir versus cefaclor in the treatment of uncomplicated urinary tract infection.
        Clin Ther. 2000; 22: 818-825
      1. FDA. Drug safety communication: FDA advises restricting fluoroquinolone antibiotic use for certain uncomplicated infections; warns about disabling side effects that can occur together. Available at: Accessed May 26, 2016.

        • Singh N.
        • Gandhi S.
        • McArthur E.
        • et al.
        Kidney function and the use of nitrofurantoin to treat urinary tract infections in older women.
        CMAJ. 2015; 187: 648-656
        • Oplinger M.
        • Andrews C.O.
        Nitrofurantoin contraindication in patients with a creatinine clearance below 60 mL/min: looking for the evidence.
        Ann Pharmacother. 2013; 47: 106-111
        • American Geriatrics Society 2015 Beers Criteria Update Expert Panel
        American Geriatrics Society 2015 updated Beers criteria for potentially inappropriate medication use in older adults.
        J Am Geriatr Soc. 2015; 63: 2227-2246
        • Santos J.M.
        • Batech M.
        • Pelter M.A.
        • Deamer R.L.
        Evaluation of the risk of nitrofurantoin lung injury and its efficacy in diminished kidney function in older adults in a large integrated healthcare system: a matched cohort study.
        J Am Geriatr Soc. 2016; 64: 798-805
        • Lutters M.
        • Vogt-Ferrier N.B.
        Antibiotic duration for treating uncomplicated, symptomatic lower urinary tract infections in elderly women.
        Cochrane Database Syst Rev. 2008; 3CD001535
        • Crider K.S.
        • Cleves M.A.
        • Reefhuis J.
        • Berry R.J.
        • Hobbs C.A.
        • Hu D.J.
        Antibacterial medication use during pregnancy and risk of birth defects: National Birth Defects Prevention Study.
        Arch Pediatr Adolesc Med. 2009; 163: 978-985
        • Ailes E.C.
        • Gilboa S.M.
        • Gill S.K.
        • et al.
        • and the National Birth Defects Prevention Study
        Association between antibiotic use among pregnant women with urinary tract infections in the first trimester and birth defects, National Birth Defects Prevention Study 1997 to 2011.
        Birth Defects Res A Clin Mol Teratol. 2016; 106: 940-949
        • Kazemier B.M.
        • Koningstein F.N.
        • Schneeberger C.
        • et al.
        Maternal and neonatal consequences of treated and untreated asymptomatic bacteriuria in pregnancy: a prospective cohort study with an embedded randomized controlled trial.
        Lancet Infect Dis. 2015; 15: 1324-1333
        • Thyagarajan B.
        • Deshpande S.S.
        Cotrimoxazole and neonatal kernicterus: a review.
        Drug Chem Toxicol. 2014; 37: 121-129
        • Widmer M.
        • Lopez I.
        • Gülmezoglu A.M.
        • Mignini L.
        • Roganti A.
        Duration of treatment for asymptomatic bacteriuria during pregnancy.
        Cochrane Database Syst Rev. 2015; 11CD000491