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

As the compelling issue of antimicrobial resistance is becoming a serious threat, more research and discussions are currently being conducted about this topic. Instillation of therapeutic antibiotics in the bladder is one such last resort option for prophylaxis and treatment of recurrent UTIs. The potential advantage of this is to bypass the systemic antibiotic absorption and to avoid the consequent side effects. Moreover, in cohorts of anuric or oliguric patients, where an adequate urine amount is not being produced, it is not clear whether intravenous administration of antibiotics will adequately treat the infection. In such a variety of cases, the use of an antibiotic bladder irrigation may be an attractive option to achieve high local drug concentrations.

The results from our review show that the intravesical antibiotics used were gentamicin, neomycin, and colistin. While a good resolution of symptomatic UTI was seen in 78%, the success was 71% and 88% in the prophylaxis and treatment groups respectively. The overall discontinuation rates for these groups were 8% and 5% respectively and the side-effects from treatment were minor and included UTI, suprapubic discomfort, allergy, and diarrhea. The dose and duration of treatment varied among studies reflecting the absence of a real standardisation.

It seems that when pushed to a corner with no other choice for treatment of recurrent UTIs, intravesical antibiotics might offer an alternative treatment option to clinicians and silver lining to patients where all other systemic treatments have failed. This treatment seems to be successful in the majority of patients at least in the short-term. Future studies need to be done prospectively with a larger cohort of patients and with a longer-term follow-up. Perhaps it is about time that they are included in the guidelines and a standardised protocol for recurrent and resistant UTIs using this treatment can be developed.

Written by: Amelia Pietropaolo and Bhaskar K Somani, Department of Urology, University Hospital Southampton NHS Trust, Southampton, United Kingdom

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