A 29-year-old woman presents with dysuria and urinary frequency for two days. Her last menstrual period was seven weeks ago. Urinalysis is positive for beta-hCG, shows moderate blood with moderate leukocyte esterase, and is positive for nitrites. Which is the most appropriate treatment?

• A. Ciprofloxacin
• B. Nitrofurantoin
• C. Cefpodoxime (She is pregnant)
• D. Amoxicillin

Answer: (C)

Treating a UTI in pregnancy requires using an antibiotic that's safe for the fetus and effective against common urinary pathogens. The nitrite-positive, leukocyte-positive urinalysis points to a bacterial cystitis caused by a gram-negative organism like E. coli, which is common in pregnancy. In early pregnancy, avoid fluoroquinolones due to fetal safety concerns and nitrofurantoin because of limited safety in the first trimester. Cefpodoxime, a cephalosporin, is considered safe in pregnancy and reliably covers Enterobacteriaceae, including E. coli, making it the best choice.