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Nitrofurantoin prophylaxis for bacteriuria and urinary tract infection in children with neurogenic bladder on
T A Schlager1, S Anderson, J Trudell
1Department of Pediatrics and Emergency Medicine, University of Virginia, Charlottesville 22906-0014, USA.
Insights
Nitrofurantoin prophylaxis did not reduce bacteriuria in children with neurogenic bladder. While it decreased symptomatic infections from E. coli, it led to more resistant bacteria without increasing resistant infections.
Area of Science:
- Pediatric Urology
- Infectious Diseases
- Pharmacology
Background:
- Children with chronic neurogenic bladder often undergo clean intermittent catheterization, increasing their risk of urinary tract infections (UTIs).
- Bacteriuria is common in this population, and prophylactic antibiotics are sometimes used to prevent symptomatic UTIs.
Purpose of the Study:
- To evaluate the efficacy of nitrofurantoin prophylaxis in reducing bacteriuria and symptomatic UTIs in children with chronic neurogenic bladder managed with clean intermittent catheterization.
Main Methods:
- A double-blind, placebo-controlled, crossover trial involving 15 children was conducted over 11 months.
- Participants received either nitrofurantoin or placebo for 5-month periods, separated by a 1-month washout.
- Weekly home visits included urine sample collection via catheterization, UTI symptom recording, and medication monitoring.
Main Results:
- Nitrofurantoin prophylaxis did not significantly decrease the overall rate of bacteriuria.
- A shift in bacterial pathogens was observed, with a decrease in Escherichia coli and an increase in resistant Klebsiella spp. and Pseudomonas spp.
- Symptomatic UTIs were halved, but this reduction was exclusively due to fewer E. coli infections; infections from resistant organisms did not increase.
Conclusions:
- Routine nitrofurantoin prophylaxis is ineffective for eradicating bacteriuria in children with chronic neurogenic bladder.
- The observed shift to resistant organisms warrants careful consideration of prophylactic strategies in this patient group.
Objective:
To determine the effect of nitrofurantoin prophylaxis on rates of bacteriuria and symptomatic urinary tract infection in children with chronic neurogenic bladder receiving clean intermittent catheterization.
Design:
Double-blind, placebo-controlled, crossover trial of 15 children receiving nitrofurantoin or placebo for 11 months (5 months receiving one drug, then 1 month of washout followed by 5 months of the alternate drug). Weekly home visits were made. During each visit a sample of bladder urine was obtained by intermittent catheterization, signs and symptoms of urinary tract infection were recorded, and all medications were recorded as well as a capsule count of the study drug.
Results:
During nitrofurantoin the frequency of bacteriuria remained high. Cultures of 74% (203 of 274) of the 274 samples on placebo were positive for a pathogen (> or = 10(4) colony-forming units per milliliter) compared with 65% (165 of 252) of the 252 samples on nitrofurantoin. The bacterial species responsible for bacteriuria, however, were altered; Escherichia coli, the most common pathogen isolated during placebo, was replaced by resistant Klebsiella spp. and Pseudomonas spp. during nitrofurantoin. The carriage of these resistant organisms tripled during nitrofurantoin. Symptomatic infection dropped in half on nitrofurantoin, but this decline was due solely to infections caused by E. coli. Despite an increased frequency of resistant organisms on nitrofurantoin prophylaxis, an increase in urinary tract infections caused by these resistant organisms did not occur.
Conclusion:
Routine use of nitrofurantoin prophylaxis in an attempt to eradicate bacteriuria in patients with chronic neurogenic bladder is not effective.