Bladder OnabotulinumtoxinA Antibiotic Prophylaxis: A Prospective RCT

Area of Science:

• Urology
• Pharmacology
• Infectious Disease

Background:

• Bladder onabotulinumtoxinA (BoNT-A) is a key treatment for overactive bladder (OAB).
• Post-procedure urinary tract infection (UTI) is the most frequent adverse event following BoNT-A injections.
• Current guidelines lack specific antibiotic prophylaxis recommendations for BoNT-A procedures.

Purpose of the Study:

• To determine if a single dose of peri-procedural antibiotics is non-inferior to multiple doses in preventing post-BoNT-A UTI.
• To compare the incidence of adverse events, including urinary retention, between single and multiple antibiotic dose groups.

Main Methods:

• A prospective, randomized, nonblinded, noninferiority trial involving 96 women undergoing office-based bladder BoNT-A.
• Patients were randomized to receive either a single antibiotic dose or a 3-day course of antibiotics.
• Exclusion criteria included a history of recurrent UTI or urinary retention. Patients were monitored for UTI, retention, and other adverse events for 4 weeks.

Main Results:

• The incidence of UTI was 2% in both the single-dose and multidose antibiotic groups (P=0.95).
• Noninferiority was not met due to the low overall UTI rate.
• One patient in the multidose group experienced urinary retention requiring catheterization, and another developed a vaginal yeast infection.

Conclusions:

• A single oral antibiotic dose appears sufficient for UTI prevention in patients receiving office-based bladder BoNT-A for uncomplicated OAB.
• This finding simplifies antibiotic prophylaxis recommendations for the procedure.
• Further research is needed to confirm these results in a broader patient population.