Choosing Wisely:

Don’t prescribe antimicrobials to patients using indwelling or intermittent catheterization of the bladder unless there are signs and symptoms of urinary tract infection.

Rationale and Comments: Antibiotics in the absence of signs and symptoms (which may include fever; altered mental status or malaise with no other cause; flank or pelvic pain; flank or suprapubic tenderness; hematuria; dysuria, urinary urgency or frequency; and, in spinal cord injury patients, increased spasticity, autonomic dysreflexia, or sense of unease) is not efficacious and risks inducing resistance to antimicrobials. This applies to both indwelling and intermittent catheterization of the bladder. The major exception is patients needing periprocedural antimicrobials. Additionally, initial placement of a suprapubic tube requires a skin puncture or incision and therefore antibiotics should be considered.
Sponsoring Organizations:
  • American Urological Association
  • Sources:
  • Infectious Diseases Society of America guidelines
  • Disciplines:
  • Urologic
  • Infectious disease
  • References: • Diagnosis, prevention, and treatment of Catheter-Associated Urinary Tract Infection in adults: 2009 International Clinical Practice Guidelines from the Infectious Diseases Society of America. [Internet]. Arlington (VA): Infectious Diseases Society of America; 2010 [cited 2014 Nov 4]. Available from:

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