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Press Release Date: January 28, 1999
There is insufficient evidence to recommend the regular use of oral antibiotics to prevent urinary tract infections (UTIs) in adults and adolescents who have abnormal bladder function because of spinal cord damage. Although research does indicate that prophylactic antibiotics reduce the amount of bacteria present, their use can double the development of bacteria that are resistant to the drugs. This is one of the major findings of an analysis by the Southern California Evidence-based Practice Center/RAND (EPC), under contract to the Agency for Health Care Policy and Research (AHCPR).
The report, entitled Prevention and Management of Urinary Tract Infections in Paralyzed Persons, examined UTIs in the two populations most commonly affected—people with spinal cord injuries (SCI), and people with multiple sclerosis (MS). Diseases of the urinary system are overall the fifth most common cause of death for people with SCI. Up to 90 percent of people with MS develop bladder dysfunction at some point, which increases their chance of urinary infection and other complications. Since the lifetime incidence of urinary tract infections among persons with spinal cord injury and multiple sclerosis is very high, every person with bladder dysfunction caused by problems of the central or peripheral nervous system should be considered at high risk for infection.
"We did not find sufficient evidence to support the routine use of preventive antibiotics for spinal cord injury and MS patients," said EPC Director Paul Shekelle, M.D. "But we recommend further research on the possible benefit of this treatment specifically for SCI and MS patients with recurrent, disabling urinary tract infections. Many clinicians believe the benefits of preventive antibiotics outweigh the risks for this subgroup, and we need to be sure that's accurate."
Other findings include:
- Clinicians treating people with spinal cord injuries and multiple sclerosis should rely on the least invasive method of bladder drainage compatible with the level of function. If a catheter is necessary, intermittent catheterization for drainage of the bladder has a lower risk of infection than indwelling catheterization.
- Because inappropriate use of antibiotics can cause side effects and resistance to the drugs, more research is needed to define clearly what constitutes a urinary tract infection, and when antibiotics are an appropriate treatment.
"Urinary tract infections are pervasive in the lives of people with spinal cord injury and multiple sclerosis, and this report shows that they can be treated effectively," said AHCPR Administrator John M. Eisenberg, M.D. "The work of this evidence center provides a foundation that will help us do even better in the future by developing the tools that we need to give high quality care to these patients."
The conclusions about the prevention and management of urinary tract infections were based on 1,278 analyzable studies, involving patients aged 13 years and older, and published after 1985. In studies of patients with spinal cord injuries, the analysis focused on non-acute patients (those more than 90 days after their injury). However, for the evaluation of antibiotic prophylaxis, additional studies of acute SCI patients were included. The evidence report was developed by the Southern California Evidence-based Practice Center/RAND in collaboration with the University of California at Los Angeles. The Consortium for Spinal Cord Medicine, consisting of 17 professional medical and patient organizations, provided advice and information to the Center. The Consortium is committed to producing a clinical practice guideline from the evidence report.
This report is part of a new series of evidence reports and technology assessments sponsored by AHCPR to provide public- and private-sector organizations with comprehensive, science-based information on common, costly medical conditions and health care technologies. The Southern California Evidence-based Practice Center/RAND is one of 12 AHCPR Evidence-based Practice Centers in the United States and Canada under contract to analyze all the relevant literature on designated topics related to prevention, diagnosis, treatment and management of common diseases and clinical conditions to develop evidence reports and technology assessments.
A four-page summary of Evidence Report Number 6, Prevention and Management of Urinary Tract Infections in Paralyzed Persons (AHCPR 99-E007), can be accessed online at http://archive.ahrq.gov/clinic/epcsums/utisumm.htm. Print copies are available from AHCPR Publications Clearinghouse by writing to P.O. Box 8547, Silver Spring, MD, 20907, or calling 800-358-9295 within the U.S., or (703) 437-2078 from outside the United States. Draft copies of the full report now are available through the AHCPR Publications Clearinghouse. Final copies of the full report will be available in mid-1999 from both the Clearinghouse and the National Library of Medicine's HSTAT full-text retrieval system.
Evidence-based practice center reports and technology assessments already released examined: sleep apnea; persons with traumatic brain injury; alcohol dependence; testosterone suppression treatment of prostate cancer; and cervical cytology (select for summaries).
Upcoming reports include depression treatment with new drugs; treatment of acute sinusitis; and management of stable angina. Recently assigned topics include management of acute chronic obstructive pulmonary disease; management of cancer pain; and management of chronic hypertension during pregnancy.
For additional information contact AHCPR Public Affairs: Karen Carp, (301) 427-1858 (KCarp@ahrq.gov); Karen Migdail, (301) 427-1855 (KMigdail@ahrq.gov). For further details about the study or interviews with EPC Director Paul Shekelle, M.D. or Principal Investigator Barbara Vickrey, M.D., please call Jess Cook, RAND Public Information Director, at (310) 451-6913.