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A pilot randomized double‐blind placebo‐controlled trial on the use of antibiotics on urinary catheter removal to reduce the rate of urinary tract infection: the pitfalls of ciprofloxacin
Author(s) -
Wazait Hassan D.,
Patel Hitenddra R.,
Van Der Meulen Jan H.P.,
Ghei Maneesh,
AlBuheissi Salah,
Kelsey Michael,
Miller Ronald A.,
Emberton Mark
Publication year - 2004
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/j.1464-410x.2004.05102.x
Subject(s) - medicine , ciprofloxacin , catheter , placebo , urinary system , asymptomatic , surgery , antibiotics , urine , randomized controlled trial , alternative medicine , pathology , microbiology and biotechnology , biology
OBJECTIVE To assess if a short course of antibiotics starting at the time of the removing a short‐term urethral catheter decreases the incidence of subsequent urinary tract infection (UTI). PATIENTS AND METHODS Patients across specialities with a urethral catheter in situ for ≥ 48 h and ≤ 7 days were recruited at the time of catheter removal. Patients were excluded if they had had recent genitourinary surgery or were on antibiotics. Eligible patients were randomly assigned to a 48‐h course of either ciprofloxacin or placebo tablets starting 2 h before catheter removal. A catheter specimen of urine was obtained before the start of the trial medication. The follow‐up was at 7 and 14 days after catheter removal, with a questionnaire for UTI symptoms, and a mid‐stream urine sample was taken. RESULTS Forty‐eight patients were recruited and had a complete follow‐up (25 received ciprofloxacin and 23 placebo). Of the ciprofloxacin group, four patients (16%) had a UTI at the follow‐up after catheter removal, and two were symptomatic. The UTI in two patients (including one of those symptomatic) was newly developed after catheter removal; the other two UTIs were a result of failure to resolve a catheter‐associated UTI. All these UTIs in the ciprofloxacin group were resistant to ciprofloxacin. Of the placebo group, three patients (13%) had a UTI at the follow‐up after removal, and one patient was symptomatic. The UTI, newly developed after catheter removal, was resistant to ciprofloxacin. The other two patients were asymptomatic; their UTIs were a result of failure to resolve a catheter‐associated UTI, and one was resistant to ciprofloxacin. CONCLUSIONS The risk of UTI (both symptomatic and asymptomatic) after removing a urethral catheter is real, even in absence of catheter‐associated UTI before removal. UTIs occurring after removing a short‐term urinary catheter had a high rate of resistance to ciprofloxacin. There was no detectable significant benefit in using prophylactic ciprofloxacin to reduce the UTI rate after catheter removal.