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Efficacy of antimicrobial intravesical treatment for uncomplicated recurrent urinary tract infections: a systematic review

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Abstract

Introduction and hypothesis

Intravesical antimicrobials (IVA) provide a localized modality of treatment for recurrent urinary tract infections (rUTIs). Owing to the sporadic use of these treatments, we conducted a systematic review on the efficacy of IVA in the management of uncomplicated rUTIs.

Methods

A systematic review was conducted for all English language articles from inception to April 2021 utilizing the Cochrane and Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards with the following databases: PubMed, OVID Embase, Biomed Central, and Scopus. References were cross-examined for further articles. Risk of bias was assessed in the articles included using the Cochrane and Joanna Briggs Institute tools.

Results

The initial search resulting in 476 titles led to 15 full-text articles. Of the 13 in the final review (2 RCTs), 3 used gentamicin and 10 used hyaluronic acid IVA. These included 764 participants, mostly women, with a mean age range of 27–80 (median: 53.1). There was a reduction in UTI frequency in 12 out of 13 studies, with 10 studies showing a statistically significant decrease. Dosages of 80 mg of gentamicin per instillation and both 40 mg and 800 mg of hyaluronic acid per instillation were found to be effective in reducing the frequency of UTIs in most studies. Eleven participants reported gentamicin-resistant infections after IVA treatment. Despite high levels of bias in selected categories, the 13 studies were designated to be of high quality for inclusion.

Conclusions

The IVAs gentamicin and hyaluronic acid with chondroitin sulphate demonstrated efficacy in the management of uncomplicated rUTIs, mostly in women.

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Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Abbreviations

IVA:

Intravesical antimicrobials

PUF:

Pelvic pain and urgency/frequency

rUTIs:

Recurrent urinary tract infections

UTIs:

Urinary tract infections

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Funding

No funds, grants, or other support was received.

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Authors and Affiliations

  1. Department of Urology, U.T. Southwestern Medical Center, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9110, USA

    Meghana Reddy & Philippe E. Zimmern

Authors
  1. Meghana Reddy
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  2. Philippe E. Zimmern
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Contributions

M. Reddy: project development, data collection, and manuscript writing/editing; P.E. Zimmern: project development, data collection, and manuscript writing/editing.

Corresponding author

Correspondence to Philippe E. Zimmern.

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None.

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All procedures performed in this study were carried out in accordance with the ethical standards of the institutional research committee (UT Southwestern IRB) and with the 1964 Declaration of Helsinki and its later amendments.

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Reddy, M., Zimmern, P.E. Efficacy of antimicrobial intravesical treatment for uncomplicated recurrent urinary tract infections: a systematic review. Int Urogynecol J 33, 1125–1143 (2022). https://doi.org/10.1007/s00192-021-05042-z

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  • DOI: https://doi.org/10.1007/s00192-021-05042-z

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