FPIN's Help Desk Answers

Antibiotic Prophylaxis for UTIs in Patients with Neurogenic Bladder

 

Am Fam Physician. 2019 Feb 1;99(3):186.

Clinical Question

Does antibiotic prophylaxis safely prevent urinary tract infections (UTIs) in patients with spinal cord injuries and neurogenic bladder?

Evidence-Based Answer

Daily antibiotic prophylaxis should not be used in patients with acute and nonacute spinal cord injuries. (Strength of Recommendation [SOR]: A, based on a meta-analysis of randomized controlled trials [RCTs].) It does not reduce the incidence of symptomatic UTIs and moderately increases the percentage of resistant cultures. However, in patients with frequent recurrent UTIs that significantly affect daily functioning, prophylaxis using a weekly oral cyclic antibiotic regimen may be beneficial. (SOR: C, small cohort study with historical controls.)

Evidence Summary

A 2002 meta-analysis compared the effects of antimicrobial prophylaxis on weekly UTI rates in patients 13 years and older with neurogenic bladder caused by acute (eight RCTs; N = 510) or nonacute (seven RCTs; N = 356) spinal cord injury.1 All patients required intermittent catheterization. Several antibiotic regimens with various dosing schedules were compared with placebo. Antibiotics included oral trimethoprim-sulfamethoxazole (TMP-SMX), oral nitrofurantoin, oral methenamine (Mandelamine), oral ciprofloxacin, and bladder instillation of neomycin plus polymyxin B. Two-thirds of the studies used TMP-SMX or nitrofurantoin for prophylaxis, which did not significantly decrease the incidence of acute symptomatic UTI compared with placebo. Of the five RCTs that evaluated for the development of antibiotic resistance, three showed a significant increase in cultures resistant to the chosen antibiotic.

A 2006 cohort study (n = 38) evaluated a weekly oral cyclic antibiotic regimen in adults with spinal cord injury who performed intermittent self-catheterization and had recurrent UTIs (more than three per year) that affected daily function.2 The average age of participants was 46 years (range: 32 to 60 years), and 58% were male. Antibiotics (amoxicillin,

Address correspondence to Kevin Frazer, MD, at frazerk@health.missouri.edu. Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.

References

1. Morton SC, et al. Antimicrobial prophylaxis for urinary tract infection in persons with spinal cord dysfunction. Arch Phys Med Rehabil. 2002;83(1):129–138.

2. Salomon J, et al. Prevention of urinary tract infection in spinal cord-injured patients. J Antimicrob Chemother. 2006;57(4):784–788.

Help Desk Answers provides answers to questions submitted by practicing family physicians to the Family Physicians Inquiries Network (FPIN). Members of the network select questions based on their relevance to family medicine. Answers are drawn from an approved set of evidence-based resources and undergo peer review. The strength of recommendations and the level of evidence for individual studies are rated using criteria developed by the Evidence-Based Medicine Working Group (http://www.cebm.net).

The complete database of evidence-based questions and answers is copyrighted by FPIN. If interested in submitting questions or writing answers for this series, go to http://www.fpin.org or e-mail: questions@fpin.org.

This series is coordinated by John E. Delzell Jr., MD, MSPH, Associate Medical Editor.

A collection of FPIN's Help Desk Answers published in AFP is available at https://www.aafp.org/afp/hda.

 

 

Want to use this article elsewhere? Get Permissions

CME Quiz

More in Pubmed

MOST RECENT ISSUE


Aug 15, 2019

Access the latest issue of American Family Physician

Read the Issue


Email Alerts

Don't miss a single issue. Sign up for the free AFP email table of contents.

Sign Up Now

Navigate this Article