What is the ideal antibiotic prophylaxis for intravesically administered Botox injection? A comparison of two different regimens

Houman, Justin; Moradzadeh, Ariel; Patel, Devin; Asanad, Kian; Anger, Jennifer T.; Eilber, Karyn S.

doi:10.1007/s00192-018-3721-4

Cited by 16 publications

(10 citation statements)

References 16 publications

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“…It is important to emphasize that the length of time used to define our postprocedure UTIs affects our incidence of UTI compared with previous studies. The overall incidence of UTI in our population was 12.9%, on the lower end of the range of results from prior [22][23][24][25] Thirty days postprocedure likely better reflects the results of prophylactic antibiotics given during or immediately after the procedure, as they are unlikely to influence UTI rates as far out as 90 days after the procedure. Urinary retention is often thought to increase the rate of UTI after intradetrusor onabotulinumtoxinA injections.…”

Section: Discussionmentioning

confidence: 79%

Antibiotics for UTI Prevention After Intradetrusor OnabotulinumtoxinA Injections

Heuer,

Gisseman,

Vaccaro

et al. 2024

UROGC

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Importance Urinary tract infections (UTIs) occur in 8.6% to 48.1% of patients after intradetrusor onabotulinumtoxinA injections. Objective The objective of this study was to evaluate both choice and duration of antibiotic prophylaxis on the incidence of UTI within 30 days after in-office onabotulinumtoxinA injections. Study Design We included a single-site, retrospective cohort of 305 patients with overactive bladder or bladder pain syndrome receiving postprocedure prophylactic antibiotics for in-office, 100-unit intradetrusor onabotulinumtoxinA injections from 2019 to 2023. Categories of antibiotic prophylaxis compared included (1) nitrofurantoin 100 mg twice daily for 3 days, (2) nitrofurantoin 100 mg twice daily for 5 days, (3) trimethoprim-sulfamethoxazole 160 mg/800 mg twice daily for 3 days, and (4) “other regimens.” Primary outcome was incidence of UTI within 30 days. Variables were compared via χ 2 test. Crude/adjusted odds were estimated using binary logistic regression. Results Incidence of UTI was 10.4% for 3-day nitrofurantoin, 20.5% for 5-day nitrofurantoin, 7.4% for 3-day trimethoprim-sulfamethoxazole, and 25.7% among “other regimens” (P = 0.023). Differences among primary regimens were substantial but not statistically significant: 3-day trimethoprim-sulfamethoxazole had 31% lower odds of UTI versus 3-day nitrofurantoin (odds ratio [OR], 0.689; P = 0.518). Compared with 3-day nitrofurantoin regimen, the 5-day nitrofurantoin regimen had twice the odds of UTI (OR, 2.22; P = 0.088). Those receiving “other regimens” had nearly 3 times the odds of UTI (OR, 2.98; P = 0.018). Results were similar adjusting for age and race. Overall urinary retention rate was 1.97%. Conclusions Prophylactic antibiotic choice and duration of treatment potentially affect UTI incidence after in-office, intradetrusor onabotulinumtoxinA injections. Nitrofurantoin and trimethoprim-sulfamethoxazole for 3 days have the lowest UTI incidence.

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Section: Discussionmentioning

confidence: 79%

Antibiotics for UTI Prevention After Intradetrusor OnabotulinumtoxinA Injections

Heuer,

Gisseman,

Vaccaro

et al. 2024

UROGC

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“…A recent review on duration of prophylaxis noted a significant decrease in infection with three days of a fluoroquinolone compared to a single dose of ceftriaxone (20.8% vs 36%, p = 0.04). 16 Another study found no difference in infection when comparing antimicrobial type or route of administration. 14 Further study is required to champion antimicrobial stewardship and identify the optimal regimen and duration of prophylaxis for intravesical BoNT.…”

Section: Discussionmentioning

confidence: 99%

Intravesical botulinum toxin: Practice patterns from a survey of Canadian urologists

Ross

Hickling²,

Maciejewski³

et al. 2022

CUAJ

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Introduction: The objectives of this study were to conduct a survey of intravesical botulinum toxin administration practices in Canada, to compare practices based on level of training, and to identify barriers to delivery. Methods: A voluntary online survey was sent to all members of the Canadian Urology Association. Respondents who provide intravesical botulinum toxin were questioned on training, surgical volume, workup, technique, and followup practices. Those with formal training in functional urology were compared to those without. Barriers to treatment delivery were identified. Results: The overall response rate was 26% (148/570). Most providers (59%) perform one to 10 treatments/month. Preoperatively, 51% perform cystoscopy and 43% perform urodynamics. A majority (66%) give routine antimicrobial prophylaxis; however, regimen and duration varied. Most (79%) perform some treatments under local anaesthetic, and 66% instill lidocaine solution for analgesia. There was a wide variation in technique with regards to the number of injections administered (range <10 to >20), volume administered per injection (range 0.5 mL to 2 mL), location of injections (bladder body vs. trigone vs. both), and depth of injection. Postoperative followup ranged from three days to three months. Respondents with fellowship training in functional/reconstructive urology performed more treatments per month and administered fewer injections per treatment. Common barriers to delivery included lack of experience/training among non-providers (45%), lack of resources (34%), and lack of medication funding (32%). Conclusions: Despite intravesical botulinum toxin being a widely accepted treatment, significant variability in practices and several barriers to delivery exist in Canada. Further study is required to optimize treatment access and quality.

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“…During the first 12 months after BoNT treatment, up to 35% of patients have UTIs, even when treated with perioperative antibiotics [ 7 ]. When comparing perioperative regiments, a three-day regimen of oral fluorchinolone was superior to a single dose of intramuscular ceftriaxone [ 25 ]. A treatment with ciprofloxacin started prior to injection decreased the risk of UTI when compared to a treatment started after injection [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

Perioperative Techniques for the Use of Botulinum Toxin in Overactive Bladder: Results of a Multinational Online Survey of Urogynecologists in Germany, Austria, and Switzerland

Lange

Koch

Lange

et al. 2023

JCM

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Introduction and Hypothesis: Botulinum toxin (BoNT) is a widely used treatment for overactive bladder (OAB). Despite its common use, no standardized treatment regimen exists so far. The aim of this survey was to evaluate the variation in perioperative treatment strategies among members of the German-speaking urogynecologic societies. Materials and Methods: A clinical practice online survey was carried out between May 2021 and May 2022, and all members of the German, Swiss, and Austrian urogynecologic societies were invited to participate. Participants were grouped in two ways. First, they were grouped into (1) urogynecologists with board certification and (2) non-board-certified general obstetricians and gynecologists (OBGYNs). Second, we set a cut-off at 20 transurethral BoNT procedures per year to differentiate between (1) high- and (2) low-volume surgeons. Results: One hundred and six completed questionnaires were received. Our results demonstrated that BoNT is mostly used as a third-line treatment (93%, n = 98/106), while high-volume surgeons used it significantly more often as a first/second-line treatment (21% vs. 6%, p = 0.029). Large variations existed in the use of perioperative antibiotics, preferred sites of injection, the number of injections, and the timing of the measurement of the postvoid residual volume (PVRV). Forty percent of participants did not offer outpatient treatment to patients. Local anesthesia (LA) was mostly used by board-certified urogynecologists (49% vs. 10%, p < 0.001) and high-volume surgeons (58% vs. 27%, p = 0.002). Injections into the trigone were also more often performed by board-certified urogynecologists and high-volume surgeons (22% vs. 3% (p = 0.023) and 35% vs. 6% (p < 0.001), respectively). PVRV was controlled between weeks 1 and 4 by only 54% of participants (n = 57/106). Clean intermittent self-catheterization (CISC) was infrequently taught (26%). Conclusions: Our survey confirmed that BoNT is widely used by urogynecologists in the three German-speaking countries, but practice patterns vary widely, and no standardized method could be detected, despite interviewing urogynecologic experts. These results clearly demonstrate that there is a need for studies to define standardized treatment strategies for the best perioperative and surgical approach regarding the use of BoNT in patients with OAB.

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What is the ideal antibiotic prophylaxis for intravesically administered Botox injection? A comparison of two different regimens

Cited by 16 publications

References 16 publications

Antibiotics for UTI Prevention After Intradetrusor OnabotulinumtoxinA Injections

Antibiotics for UTI Prevention After Intradetrusor OnabotulinumtoxinA Injections

Intravesical botulinum toxin: Practice patterns from a survey of Canadian urologists

Perioperative Techniques for the Use of Botulinum Toxin in Overactive Bladder: Results of a Multinational Online Survey of Urogynecologists in Germany, Austria, and Switzerland

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