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Short-course aminoglycoside therapy in patients with spinal cord injury. Standard dose versus low dose
Abstract:
Twenty-nine patients with spinal cord injury and asymptomatic urinary tract infection were treated with standard or reduced doses of tobramycin and amikacin. The patients received five days of intramuscular antibiotics. Most of the patients in the tobramycin groups had Pseudomonas aeruginosa infection and most of those in the amikacin group had either Proteus rettgeri or Providencia stuartii infections. Only 1 patient had a positive urine antibody coating test. High antibiotic concentrations were demonstrated in the urine of all patients during therapy. Urine cultures were obtained two and seven days after completion of therapy. Forty-eight per cent of the patients were cured, while 31 per cent showed persistence or relapse, and 21 per cent had reinfection with other bacteria. No significant differences in results were observed between the standard-dose and low-dose regimens and between the amikacin and tobramycin groups. The low success rate of the regimens used may indicate the need to evaluate alternative therapeutic regimens to treat urinary tract infections in this special group of patients.
Insights
Standard or reduced doses of tobramycin and amikacin showed limited success in treating asymptomatic urinary tract infections in spinal cord injury patients. Alternative treatments may be needed for this population.
Area of Science:
- Urology
- Infectious Diseases
- Nephrology
Background:
- Spinal cord injury (SCI) patients often experience asymptomatic bacteriuria.
- Urinary tract infections (UTIs) are a common complication in SCI patients.
- Effective antibiotic regimens for UTIs in SCI patients require further investigation.
Purpose of the Study:
- To evaluate the efficacy of tobramycin and amikacin in treating asymptomatic urinary tract infections in patients with spinal cord injury.
- To compare standard-dose versus reduced-dose antibiotic regimens.
- To assess the impact of different antibiotics on specific bacterial pathogens.
Main Methods:
- Twenty-nine SCI patients with asymptomatic UTIs received five-day intramuscular courses of tobramycin or amikacin.
- Standard and reduced doses of antibiotics were administered.
- Urine cultures were analyzed before and after treatment (two and seven days post-therapy).
- Antibiotic concentrations in urine were measured.
Main Results:
- Overall cure rate was 48%, with 31% showing persistence/relapse and 21% reinfection.
- No significant differences in efficacy were found between standard and reduced doses.
- No significant differences were observed between tobramycin and amikacin.
- Pseudomonas aeruginosa was common in tobramycin groups; Proteus rettgeri/Providencia stuartii in amikacin groups.
Conclusions:
- Current tobramycin and amikacin regimens demonstrate a low success rate for treating asymptomatic UTIs in SCI patients.
- Dose adjustments and antibiotic choice did not significantly alter treatment outcomes.
- Alternative therapeutic strategies are warranted for managing UTIs in this vulnerable patient population.