Onabotulinum Toxin A-Led Urinary Tract Infections-Should we Safeguard? A Randomized Controlled Trial.

Area of Science:

• Urology
• Pharmacology
• Infectious Disease

Background:

• Onabotulinum toxin A injections are a common treatment for overactive bladder (OAB).
• Urinary tract infections (UTIs) are a potential complication following invasive procedures.
• The necessity of antibiotic prophylaxis for UTI prevention in this context is debated.

Purpose of the Study:

• To evaluate the need for antibiotic prophylaxis to prevent UTIs before Onabotulinum toxin A injections for OAB.
• To determine if foregoing antibiotic prophylaxis is non-inferior to its administration.

Main Methods:

• A multi-centered, nonblinded, randomized controlled trial was conducted.
• Participants were randomized to receive oral antibiotics or no treatment.
• The primary outcome was the UTI rate at 2 weeks post-procedure; secondary outcomes included post-void residuals and UTI rates at 6 weeks.

Main Results:

• UTI rates at 2 weeks were 9.2% (antibiotics) vs. 10.9% (control), p=0.75.
• UTI rates at 6 weeks were 4.7% (antibiotics) vs. 11.1% (control), p=0.21.
• No pre-procedure factors predicted UTI development at 2 weeks; urinary retention rate was 0.8%.

Conclusions:

• No significant difference in UTI rates was observed between groups at 2 and 6 weeks.
• Omitting antibiotic prophylaxis may be considered to combat antimicrobial resistance.
• This approach may be safe for OAB treatment with Onabotulinum toxin A.