(UroToday.com) Intravesical antimicrobials (IVA) can provide a localized modality of treatment for uncomplicated recurrent urinary tract infections (rUTIs). This was a systematic review on the efficacy of IVA in the management of rUTIs. The review included articles from inception to April 2021, utilizing the Cochrane and PRISMA standards with the following databases: Pubmed, OVID Embase, Biomed Central, and Scopus. References were cross-examined for further articles.
Inclusion was full-text, English language articles on IVA treatments for particularly female patients over the age of the 18 were included. Studies treating rUTIs secondary to neurogenic bladder, spinal cord injury, use of non-microbial agents, male or pediatric only populations were excluded. Risk of bias was assessed in the included articles using the Cochrane and Joanna Briggs Institute tools.
The initial search resulted in 476 titles leading to 15 full-text articles. Of the 13 in the final review (2 RCTs), 3 used gentamicin and 10 used hyaluronic acid IVA. These included 764 participants, mostly female (mean age range of 27-80, median: 53.1). There was a reduction in UTIs in 12 out of 13 studies, 10 showed a statistically significant decrease. In most studies, dosages of 80mg of gentamicin per instillation and both 40mg and 800mg of hyaluronic acid per instillation were found to be effective in reducing the UTI frequency. Eleven participants (13%) reported gentamicin-resistant infections after IVA treatment. Despite high levels of bias in select categories, the 13 studies were designated to be high quality for inclusion.
This study demonstrated that IVA of gentamicin and hyaluronic acid with chondroitin sulphate was efficacious in the management of rUTIs, mostly in females. In addition, localized treatments show limited adverse effects systemically even across different dosages and treatment regimens. The authors recommended that further research on defining the ideal candidates for IVA treatment including number of rUTIs is needed.
Presented by: Meghana Reddy, Philippe Zimmern, Department of Urology, University of Texas Southwestern Medical Center
Written by: Diane K. Newman, DNP, ANP-BC, FAAN, Adjunct Professor of Urology in Surgery, Perelman School of Medicine, University of Pennsylvania and Co-Director of the Penn Center for Continence and Pelvic Health at the 2022 Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU) Winter Meeting, February 22 - 26, 2022