Pd54-03 Single-Dose Versus Multi-Dose Course of Prophylactic Antibiotics for Bladder Onabotulinumtoxin-a Injection: A Prospective Randomized Controlled Trial

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Overactive Bladder II (PD54)1 May 2024PD54-03 SINGLE-DOSE VERSUS MULTI-DOSE COURSE OF PROPHYLACTIC ANTIBIOTICS FOR BLADDER ONABOTULINUMTOXIN-A INJECTION: A PROSPECTIVE RANDOMIZED CONTROLLED TRIAL Lauren Gleich, Chen Shenhar, Jacquelyn Booher, Howard Goldman, Sandip Vasavada, and Emily Slopnick Lauren GleichLauren Gleich , Chen ShenharChen Shenhar , Jacquelyn BooherJacquelyn Booher , Howard GoldmanHoward Goldman , Sandip VasavadaSandip Vasavada , and Emily SlopnickEmily Slopnick View All Author Informationhttps://doi.org/10.1097/01.JU.0001008724.35538.9c.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Bladder onabotulinumtoxinA (BoNT-A) is a widely used third-line treatment for patients with refractory overactive bladder (OAB). The most common adverse event is postoperative urinary tract infection (UTI). Despite this, there are no specific guidelines for antibiotic prophylaxis for bladder BoNT-A injection. Our primary aim was to establish noninferiority for incidence of post-procedure UTI with single versus multiple dose peri-procedural antibiotic prophylaxis. METHODS: Adult patients undergoing office-based bladder BoNT-A were enrolled in this single center, prospective, randomized non-inferiority trial. Exclusion criteria included history of recurrent UTI, catheter use, or history of urinary retention. Patients were randomized 1:1 into two treatment arms a single in-office dose versus three days of post-procedural antibiotics. For the multi-day group, twice daily dosing of trimethoprim/sulfamethoxazole, cephalexin, nitrofurantoin, or ciprofloxacin were prescribed as first, second, third-, and fourth-line therapy, respectively. Antibiotic choice was based on individual patient's allergies, prior urine culture sensitivities, and drug interactions. Patients and providers were not blinded. Additional post-procedure care, including evaluation and treatment for UTI, was routine. Participants were assessment at four weeks post-procedure for any interval treatment of UTI, urine culture results, urinary retention, or treatment-associated adverse effects. RESULTS: Recruitment of 96 women occurred from December 2022 to June 2023, with 46 (47.92%) in the single dose and 50 (52.08%) in the multi-dose arm. Mean age was 66.8 yrs (28-93 yrs, p=0.38). Patient characteristics, medical comorbidities, and vaginal estrogen use was not significantly different between groups (p>0.05). Overall, 2 patients (2.1%) developed UTI following BoNT-A, 1 (2.17%) in the single dose arm and 1 (2%) in the multi dose arm (p=0.9525). One patient (2.17%, p=0.1704) developed retention requiring catheterization and one developed a vaginal yeast infection, both in the multi dose arm. CONCLUSIONS: For office injection of bladder BoNT-A for uncomplicated OAB, a single dose of oral prophylactic antibiotic is non-inferior to a multiple doses course for the prevention of UTI. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e1143 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Lauren Gleich More articles by this author Chen Shenhar More articles by this author Jacquelyn Booher More articles by this author Howard Goldman More articles by this author Sandip Vasavada More articles by this author Emily Slopnick More articles by this author Expand All Advertisement PDF downloadLoading ...