Intravesical gentamicin useful in treatment of intractable recurrent UTIs
Intravesical gentamicin may effectively reduce the frequency of infections in adult patients who have multiple symptomatic urinary tract infections (UTIs) refractory to conventional treatment, with the treatment being well tolerated and showing no evidence of systemic absorption, according to a retrospective study.
The study included 27 patients (average age 55 years; 74 percent female) treated with intravesical gentamicin over a 2-year period. Patients were instructed to instill gentamicin into the bladder on a nightly basis. Inclusion criteria were failure of standard therapy, having six or more cultured-confirmed UTIs over a 1-year period, or at least one hospital admission with sepsis. Serum gentamicin levels were measured 7 days after initiation, with the treatment discontinued if the level was >1 mg/L.
Treatment period lasted an average of 26 months, with a starting daily dose of 80 mg. At treatment initiation, 17 patients were performing intermittent self-catheterization (ISC), five had suprapubic catheters, three were voiding, and two had ileal conduits. In total, six discontinued treatment and none of these patients showed side effects as a result of the instillations.
In terms of efficacy, 22 patients had less frequently occurring infections after initiating intravesical gentamicin treatment. The drug was found to be well tolerated. Side effects were uncommon and none directly related to gentamicin.
Overall, researchers pointed out that patients were generally very satisfied with the treatment. Following intravesical gentamicin, the patients reported a marked improvement in their quality of life and found the procedure easy to use.
“The single most important barrier to treatment has been in those who have not wanted to or were not able to carry out ISC,” they said.
Given the lack of long-term data on the use of intravesical gentamicin, potential side effects should be closely monitored, they added. Additional randomized controlled trials comparing standard methods of preventing recurrent UTIs vs gentamicin would be useful.