NEW YORK (Reuters Health) – Urinary tract infections occur quite often after patients are given detrusor injections of botulinum toxin A (BoNT-A) to reduce bladder overactivity, so prophylactic antibiotics should be considered, a European group reports.

They note in BJU International published online June 29 that guidelines on treating patients with neurogenic detrusor overactivity make no recommendations about antibiotic prophylaxis with intadetrusor BoNT-A injections.

To investigate the rate of symptomatic urinary tract infections in this setting, Dr. Xavier Gamé at CHU Rangueil in Toulouse, France, and colleagues prospectively studied 42 patients being treated with intradetrusor BoNT-A after failing anticholinergic therapy.

Neurologic impairment included spinal cord injury, multiple sclerosis, myelomeningocele, stroke and myelitis. The patients were given either Botox 300 U in 30 injection sites or Dysport 750 U in 20 sites via rigid cystoscopy under local anesthesia.

“During the first week after the injections, three patients (7.1%) had symptomatic UTIs. The symptoms of the UTIs were fever in two patients and worsening of neurological status in one,” the researchers found. “Escherichia coli (E. coli) was the causative organism in all cases.”

The fact that none of the subjects in the study had a history of recurrent UTIs and all had sterile urine the week before the procedure “argues for the use of antibiotic prophylaxis,” the team suggests.

Antibiotics used should be based on local ecology, they advise, but should include E. coli coverage.

That said, they point out that the impact of antibiotic prophylaxis “has to be assessed through a controlled randomized trial.”

Reference:

Risk of urinary tract infection after detrusor botulinum toxin A injections for refractory neurogenic detrusor overactivity in patients with no antibiotic treatment

BJU Int 2010