Home' Australian Pharmacist : Australian Pharmacist December 2012 Contents 948 Australian Pharmacist December 2012 I ©Pharmaceutical Society of Australia Ltd.
The purpose of this evidence summary is to
provide the best available information on
the efficacy of prophylactic antibiotics for
reducing urinary tract infections following
urodynamic studies. For the full Cochrane
review, please refer to Foon R, Toozs-
Hobson P, Latthe P. Prophylactic antibiotics
to reduce the risk of urinary tract infections
after urodynamic studies. Cochrane Database
of Systematic Reviews 2012, Issue 10. Art.
No.: CD008224. DOI: 10.1002/14651858.
Urodynamic testing is a diagnostic tool to
evaluate bladder function. The testing uses
Fluoroscopy to visualise and measure bladder
capacity, bladder emptying, bladder pressure,
urinary incontinence and shape and size of
bladder.2 The use of prophylactic antibiotics
before or after these procedures has been
controversial because of the possibility of
adverse reactions and the emergence of
antibiotic resistance.3 The reported incidence
of bacteraemia during these procedures
was reported to be up to 5%. Severe
complications associated with urinary tract
infections include pyelonephritis, which is
associated with impairment of renal function
and renal disease in paediatric patients.4
The use of antibiotics might reduce the risk of
bacterial invasion of the urinary tract during
catheterisation and subsequent symptomatic
UTI following invasive cystometry.5 Hence, the
aim of this evidence summary is to examine
the efficacy of prophylactic antibiotics for the
reduction of urinary tract infections following
Characteristics of the studies
The studies selected for the systematic review
were randomised and quasi-randomised
controlled trials where at least one arm
includes giving a prophylactic antibiotic
to a person having a urodynamic study.
The intervention included any type or dose of
antibiotic given via any route, from 24 hours
before to up to 72 hours after urodynamics.
The antibiotic course can be for any duration
including a single dose. Comparison
interventions may include no treatment,
placebo, any type of urinary antiseptic,
cranberry juice or changes in fluid intake
(such as advice to increase fluid intake).
Quality of the research
All studies included in the report were of
moderate methodological quality. The studies
were assessed for selection bias, blinding
method, incomplete and selective reporting.
• Databases such as the Cochrane
Incontinence Group Specialised Trials
Register (searched 10 Dec 2009), the
Cochrane Central Register of Controlled
Trials (CENTRAL), MEDLINE (Jan 1966 to
Jan 2009), CINAHL (Jan 1982 to Jan 2009),
Embase (Jan 1966 to Jan 2009), PubMed
(1 Jan 1980 to Jan 2009), LILACS (up to Jan
2009), TRIP database (up to Jan 2009), and
the UK NHS Evidence Health Information
Resources (searched-10 Dec 2009) were
• Nine randomised studies with a total
of 973 patients between the ages of 18
and 82 years, of which 230 patients were
• The primary outcome was urinary tract
infection or asymptomatic bacteriuria.
• Secondary outcomes include adverse
effects such as haematuria, fever, dysuria,
adverse events as a result of or in reaction
to antibiotics (e.g. allergic reaction,
rash) and the need for analgesia. Other
outcomes measures such as health
economic outcomes were also considered.
• The antibiotics described in the trials were
a single dose in six trials and multiple doses
in three trials. The antibiotics used were
amoxicillin and clavulanate, ciprofloxacin,
cotrimoxazole, norfloxacin, nitrofurantoin,
ciprofloxacin and trimethoprim.
• Prophylactic antibiotics reduced the risk
of significant bacteriuria, risk ratio (RR)
0.35, 95%CI 0.22 to 0.56) in both men
• The administration of prophylactic
antibiotics also reduced the risk of
haematuria (RR 0.46, 95%CI 0.23 to 0.91) in
both men and women.
• There was no statistically significant
difference in the primary outcome, risk of
symptomatic urinary tract infection (RR
0.73, 95% CI 0.52 to 1.03); or in the risk
of fever (RR 5.16, 95% CI 0.94 to 28.16) or
dysuria (RR 0.83, 95% CI 0.5 to 1.36).
• Only two of 135 people had a side effect to
• The number of patients needed to treat
with antibiotics to prevent bacteriuria
• Amongst women, the number needed to
treat to prevent bacteriuria was 13.4; while
amongst men it was 9.1.
Implications for research and practice
This review not only aims to guide clinicians
in the use of prophylactic antibiotics in
patients undergoing urodynamic studies
but also highlights the lack of good quality
trials with sufficient numbers addressing
the above topic.
There is evidence to support that
prophylactic antibiotics reduce the risk
of significant bacteriuria following the
procedure, however their effectiveness in
reducing the symptoms of UTIs is unclear.
1. Foon R, Toozs-Hobson P, Latthe P. Prophylactic antibiotics to
reduce the risk of urinary tract infections after urodynamic studies.
Cochrane Database of Systematic Reviews 2012, Issue 10. Art. No.:
CD008224. DOI: 10.1002/14651858.CD008224.pub2.
2. Onur R, Ozden M, Orhan I, Kalkan A, Semercioz A. Incidence of
bacteraemia after urodynamic study. Journal of Hospital Infection
3. Porru D, Madeddu G, Campus G, Montisci I, Scarpa RM, Usai E.
Evaluation of morbidity of multi-channel pressure flow studies.
Neurourology and Urodynamics 1999;18(6):647--52.
4. Schaeffer A. Catheter associated bacteriuria. The Urologic Clinics
of North America 1986;13:735--47.
5. Siracusano S, Knez R, Tiberio A, Alfano V, Giannantoni A,
Pappagallo G. The usefulness of antibiotic prophylaxis in
invasive urodynamics in postmenopausal female subjects
International Urogynecology Journal and Pelvic Floor Dysfunction
Dr Hanan Khalil is the Director of the
Centre for Chronic Disease Management, a
collaborating centre of the Joanna Briggs
Institute, Faculty of Medicine, Nursing and
Health Sciences, Monash University, and
a reviewer for the consumer group of the
The e cacy of prophylactic
antibiotics for reducing UTIs
By Dr Hanan Khalil
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