A Multicenter Prospective Cohort Study of Antibiotics for OnabotulinumtoxinA
Elise Morocco, Lannah Lua-Mailland, Adrienne Werth, Danielle Carr, Sarah Rabice, Sarah Ashmore, Vi Duong, Margaret Wilkes, Wesley Nilsson, Tanaz FerzandiImportance
Urinary tract infection (UTI) is the most common complication of intradetrusor onabotulinumtoxinA (BTX-A) injection. Despite this, there are no evidence-based guidelines on antibiotic prophylaxis.
Objectives
Our primary aim was to determine whether antibiotic prophylaxis decreased symptomatic, culture-proven UTI rates within 6 weeks of intradetrusor BTX-A injection. Our secondary aims were to determine if there are differences between antibiotic regimens and to identify risk factors for developing a UTI.
Study Design
This was a prospective, observational multicenter cohort study of female patients receiving BTX-A for idiopathic overactive bladder. We compared patients who received antibiotics (nitrofurantoin or trimethoprim-sulfamethoxazole) to those who did not. To detect a 15% difference in UTI rates between groups (80% power, alpha = 0.05), 270 participants were needed.
Results
A total of 282 participants ultimately received BTX-A and were included in the analysis. One hundred eighty-one (62.6%) were in the antibiotic cohort and 101 (35.8%) were in the no-antibiotic cohort. The overall rate of symptomatic, culture-proven UTI was 12.1%, and there was no difference between the antibiotic and no-antibiotic cohort (10.6% vs 14.9%, respectively;
Conclusions
Our study did not find a lower rate of symptomatic, culture-proven UTI among participants who took antibiotics compared with those who did not.