Patients that use clean intermittent self-catheterization (CISC) are at an increased risk of repeated symptomatic urinary tract infections (UTIs). While the prevention of UTIs with continuous antibiotic prophylaxis in this patient population has been previously studied, results have been inconsistent. In this randomized controlled trial, 404 community-dwelling users of CISC with recurrent UTIs were randomized to receive either antibiotic prophylaxis once daily or no prophylaxis for 12 months, to determine whether continuous antibiotic prophylaxis reduces the incidence of symptomatic UTI. The antimicrobials given were 50 mg nitrofurantoin, 100 mg trimethoprim, or 250 mg cephalexin. Researchers found that the incidence of symptomatic antibiotic-treated UTI over the 12-month period was significantly reduced in the intervention group (RR 0.52, 95% CI 0.44 to 0.61, p<0.0001), corresponding to a 48% reduction. Antibiotic resistance was, however, more frequent in urinary isolates from the prophylaxis group. This study therefore shows that continuous antibiotic prophylaxis is effective in reducing UTI frequency in CISC users. The use of antibiotic prophylaxis, however, must be weighed against the increased risk of antibiotic resistance to urinary bacteria.
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