Weekly sequential antibioprophylaxis for recurrent UTI among patients with neurogenic bladder: a randomized controlled trial

BACKGROUND: Recurrent urinary tract infections (R-UTIs) are the main cause of morbidity and hospitalisations in subjects with neurogenic bladder (NB) due to spinal cord injury (SCI). We evaluated the efficacy of weekly oral cyclic antibiotic (WOCA) prophylaxis, i.e. the alternate weekly administration of two antibiotics, in preventing R-UTI. METHODS: Randomized (1:1), open-label, superiority controlled trial, comparing WOCA prophylaxis to no prophylaxis (control) for six months in patients with NB due to SCI, using clean intermittent self-catheterization, and suffering from R-UTIs. Primary outcome: incidence of symptomatic antibiotic-treated UTIs. Secondary outcomes: number of febrile UTIs, number of hospitalisations, WOCA tolerance, antibiotic consumption, number of negative urine cultures, and emergence of bacterial resistance in urinary, intestinal and nasal microbiota. RESULTS: A total of 45 patients were either allocated to the WOCA group (n=23) or the control group (n=22). Median incidence of symptomatic antibiotic-treated UTIs was 1.0 [IQR 0.5; 2.5] in the WOCA group vs. 2.5 [IQR 1.2; 4.0] (p=0.0241) in the control group. No febrile UTI were recorded in the WOCA group vs. 9 (45.0%) (p<0.001) in the control group. Median number of additional antibiotic treatment was 0.0 [IQR 0.0; 2.0] vs. 3.0 [2.0; 5.0] (p=0.004) in the WOCA and control groups, respectively. Only few adverse events were reported. No impact on emergence of bacterial resistance was observed. CONCLUSIONS: WOCA is efficient and well-tolerated in preventing R-UTI in SCI patients. In our study, we did not observe any emergence of antibiotic resistance in digestive and nasal microbiological cultures.