Intravesical gentamicin instillation cuts number of UTI episodes
Intravesical instillation of gentamicin appears to result in reduced number of urinary tract infection (UTI) episodes and degree of antimicrobial resistance, a study has shown.
The study included 63 adults with recurrent UTI caused by multidrug-resistant (MDR) pathogens. All of them received overnight intravesical gentamicin instillations for 6 months.
Recurrence rate of UTIs, the primary study outcome, dropped from 4.8 at baseline to 1.0 during intravesical treatment. The secondary outcome of resistance to uropathogens also improved, with the rate falling from 78 percent to 23 percent.
In terms of safety, there were no reports of systemic absorption or clinically relevant side effects.
Intravesical instillations have long been used in urology, mostly for treating nonmuscle invasive bladder cancer. Gentamicin is believed to be an ideal antibiotic for intravesical instillation, having been shown to be bactericidal against most gram-negative genitourinary pathogens including some multiresistant organisms. Intravenous use of this drug is limited by potential nephrotoxic and ototoxic effects, although the bladder provides an impermeable surface and allows the drug to be concentrated at high levels in the target area. Another advantage of not administering it systemically is the avoidance of side effects such as nausea, diarrhoea and colonic superinfection. [Int J Antimicrob Agents 2010;36:485-490]
Recurrent UTIs are a common problem, negatively affecting quality of life and possibly requiring hospital admission. About one-third of females will have a UTI in their lifetime, with evidence showing that 24–50 percent of them will have a recurrence within 6 months of the index infection. [Neurourol Urodyn 2017;36:2109-2116]