Urinary Catheter Policies for Long-Term Bladder Drainage

A Cochrane review [Abstract] 1 included 8 studies (4 crossover, 4 parallel-group RCTs) with a total of 504 subjects. No eligible trials were identified that compared alternative routes of catheter insertion.

Four trials compared antibiotic prophylaxis with antibiotics when clinically indicated. For patients using intermittent catheterisation, there were inconsistent findings about the effect of antibiotic prophylaxis on symptomatic urinary tract infection (UTI). For patients using indwelling urethral catheterisation, one small trial reported fewer episodes of symptomatic UTI in the prophylaxis group.

Four trials compared antibiotic prophylaxis with giving antibiotics when microbiologically indicated. For patients using intermittent catheterisation, there was limited evidence that receiving antibiotics reduced the rate of bacteriuria (asymptomatic and symptomatic). There was weak evidence that prophylactic antibiotics were better in terms of fewer symptomatic bacteriuria.

Authors' comment: Possible benefits of antibiotic prophylaxis must be balanced against possible adverse effects, such as development of antibiotic resistant bacteria; these cannot be reliably estimated from currently available trials.

References

• Niël-Weise BS, van den Broek PJ, da Silva EM et al. Urinary catheter policies for long-term bladder drainage. Cochrane Database Syst Rev 2012;(8):CD004201. [PubMed]