Actionable Nuggets for SCI (2nd ed., 2013)
Urinary tract infections (UTIs) in individuals with neurogenic bladder are often polymicrobial and caused by a much wider variety of pathogens than in the general population.
Prescribe fluoroquinolones as first-line for febrile or chronic symptomatic UTI.
Evidence-based Best Practice:
Guidelines for selecting antimicrobial agents in SCI patients are similar to guidelines for the general population. They include identification of the infecting organism and its antimicrobial susceptibility pattern, and assessment of host resistance and risk factors. Once symptomatic UTI is confirmed in an individual with SCI (see Nugget #4), first-line treatment is one of the fluorquinolones (e.g. ciprofloxacin, ofloxacin). Treatment should be started without waiting for culture results, and a minimum of 14 days of treatment should be offered for recurrent UTI. Routine prophylactic antibiotics should not be used when changing catheters, and asymptomatic infections should not be treated with antibiotics, due to significant risk of antimicrobial resistance.
A randomized controlled trial showed a clinical cure rate of 90% for ofloxacin, compared to 57% for trimethoprim-sulphamethoxazole (TMP-SMX) or other antibiotics. In addition, 67% of bacteria were eradicated with ofloxacin compared with 35% for TMP-SMX or other. Another study showed that ciprofloxacin eradicated 92% of bacteria, while ofloxacin did so in 71% and norfloxacin in 56% of cases.
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