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      Use and Effectiveness of Antimicrobial Intravesical Treatment for Prophylaxis and Treatment of Recurrent Urinary Tract Infections (UTIs): a Systematic Review

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          Abstract

          Purpose of Review

          Intravesical antibiotics (IVA) has been used for prophylaxis and treatment of recurrent urinary tract infections (rUTIs). However, there is a lack of comprehensive evidence and consensus on its use. We conducted a systematic review to collect all available data about the effectiveness of IVA in prevention and treatment of rUTIs and to give an overview on the outcomes to date.

          Methods

          A systematic review was carried out for all English language articles from inception to August 2017, according to the Cochrane and PRISMA standards using MEDLINE, Scopus, Biomed Central, EMBASE, CINAHL, and Web of Science with references cross-checked and individual urology journals hand-searched.

          Results

          After an initial identification of 658 studies, we screened 37 abstracts and 18 full-text papers of which 11 were included in our final review. This included 285 patients with a mean age of 52 years and a female:male ratio of 129:117. The IVA used was gentamicin, neomycin/polymyxin, neomycin or colistin and IVA was used for rUTIs as prophylaxis in 5 studies ( n = 168) and treatment in 6 studies ( n = 117). Overall, a good reduction in symptomatic UTI was seen in 78%, with a short-term success rate and discontinuation rates of 71% (120/168) and 8% (14/168) in the prophylaxis group and 88% (103/117) and 5% (6/117) in the treatment groups respectively. There was a change in the sensitivity of organisms in 30% (50/168) and 23% (27/117) in the treatment and prophylaxis groups respectively. Twenty patients discontinued their IVA instillations which were higher for the non-gentamicin group (11%) compared to the gentamicin group (5%). The side effects were minor and included allergy, suprapubic discomfort, autonomic dysreflexia, urinary tract infections and diarrhoea.

          Summary

          Intravesical antimicrobial instillation seems to be a relatively safe and effective method for the prophylaxis and treatment of recurrent UTIs, especially in the short term. It gives clinicians an alternative treatment modality in high-risk patients predisposed to UTIs where all other forms of systemic treatments have failed.

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          Most cited references19

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          Gentamicin bladder instillations decrease symptomatic urinary tract infections in neurogenic bladder patients on intermittent catheterization.

          This study aimed to determine if gentamicin bladder instillations reduce the rate of symptomatic urinary tract infection (UTI) in neurogenic bladder (NGB) patients on intermittent self-catheterization (ISC) who have recurrent UTIs. Secondary aims were to examine the effects of intravesical gentamicin on the organism resistance patterns.
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            Safety of gentamicin bladder irrigations in complex urological cases.

            Recurrent urinary tract infections are common in complex pediatric urological cases, particularly those requiring clean intermittent catheterization. At our institution gentamicin bladder irrigations have been used for antimicrobial prophylaxis and to treat symptomatic bacteriuria, particularly when the infection does not involve the upper urinary tract. The purpose of this study was to assess the safety of this therapy.
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              Evaluation of 3 methods of bladder irrigation to treat bacteriuria in persons with neurogenic bladder.

              We conducted a randomized, double-blind comparison of twice daily bladder irrigation using 1 of 3 different solutions in community-residing persons with neurogenic bladder who used indwelling catheters to evaluate efficacy in treatment of bacteriuria.
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                Author and article information

                Contributors
                ameliapietr@gmail.com
                patrick.jones1@nhs.net
                mvm198@soton.ac.uk
                brianbirch@aol.com
                00442380795273 , bhaskarsomani@yahoo.com , b.k.somani@soton.ac.uk
                Journal
                Curr Urol Rep
                Curr Urol Rep
                Current Urology Reports
                Springer US (New York )
                1527-2737
                1534-6285
                9 August 2018
                9 August 2018
                2018
                : 19
                : 10
                : 78
                Affiliations
                [1 ]GRID grid.430506.4, Department of Urology, , University Hospital Southampton NHS Trust, ; Southampton, SO16 6YD UK
                [2 ]ISNI 0000 0004 1936 9297, GRID grid.5491.9, Primary Care and Population Sciences, , University of Southampton, ; Southampton, UK
                Article
                834
                10.1007/s11934-018-0834-8
                6097067
                30094687
                4fc8ccc3-3ae9-4cb0-9e70-4083a449ff8e
                © The Author(s) 2018

                Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

                History
                Funding
                Funded by: University of Southampton
                Categories
                Lower Urinary Tract Symptoms & Voiding Dysfunction (J Sandhu, Section Editor)
                Custom metadata
                © Springer Science+Business Media, LLC, part of Springer Nature 2018

                Urology
                uti,urinary infection,recurrent,intravesical antibiotics,antimicrobial resistance
                Urology
                uti, urinary infection, recurrent, intravesical antibiotics, antimicrobial resistance

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