Background: Urinary Tract Infection is one of the most commonly encountered diseases in pregnancy. Proper and adequate antibiotic treatment must be given to avoid obstetrical complications but its safety, cost, convenience, side effects and development of resistance limits choices in antimicrobials. Objective: To compare the Efficacy of Single Dose Fosfomycin Trometamol and a Five-Day treatment with Nitrofurantoin in the Treatment of Urinary Tract Infection among pregnant patients seen at the Out Patient Department of FEU-NRMF Medical Center Methods: Included were 124 pregnant women aged 18 to 40 years old at 16 to 32 weeks age of gestation diagnosed with urinary tract infection through urine culture with 100 to > 100, 000 cfu/ml of a single pathogen, with or without symptoms. Participants were randomly allocated to Group A: single 3 gram dose of Fosfomycin and Group B: Nitrofurantoin 100 mg 2x a day for five days. Microbiologic and clinical cure rate, adverse effects, susceptibility and resistance patterns were compared between the 2 treatment arms using chi square. Clinical cure rate was followed up on days 7, 14 and 30 post treatment. T-test was used to compare the actual zone of inhibition between the 2 treatment groups. Results: No significant difference in the microbiologic and clinical cure rate between single dose Fosfomycin trometamol and 5-day Nitrofurantoin in cure of uncomplicated urinary tract infection among pregnant women. Microbiologic cure rate of 98.41% for single dose Fosfomycin and 95.38% for five-day regimen of Nitrofurantoin. Most isolates were sensitive to both treatment arms. Only 2 isolates developed resistance to Nitrofurantoin, none to Fosfomycin. Escherichia Coli is still the most common isolate with prevalence rate nearing 50%. Conclusion: Single Dose Fosfomycin trometamol is comparable with 5-day Nitrofurantoin in the treatment of Urinary Tract Infection among pregnant women. It is a cost-beneficial and safe primary treatment for urinary tract infection at any trimester during pregnancy.