NITROFURANTOIN PROPHYLAXIS FOR BACTERIURIA AND URINARY-TRACT INFECTION IN CHILDREN WITH NEUROGENIC BLADDER ON INTERMITTENT CATHETERIZATION

Objective: To determine the effect of nitrofurantoin prophylaxis on ra tes of bacteriuria and symptomatic urinary tract infection in children with chronic neurogenic bladder receiving clean intermittent catheter ization. Design: Double-blind, placebo-controlled, crossover trial of 15 children receiving nitrofurantoin or placebo for 11 months (5 month s receiving one drug, then 1 month of washout followed by 5 months of the alternate drug). Weekly home visits were made. During each visit a sample of bladder urine was obtained by, intermittent catheterization , signs and symptoms of urinary tract infection were recorded, and all medications were recorded as well as a capsule count of the study dru g. Results: During nitrofurantoin the frequency of bacteriuria remaine d high. Cultures of 74% (203 of 274) of the 274 samples on placebo ii ere positive for a pathogen (greater than or equal to 10(4) colony-for ming units per milliliter) compared with 65% (165 of 252) of the 252 s amples on nitrofurantoin. The bacterial species responsible for bacter iuria, however, were altered; Escherichia coli, the most common pathog en isolated during placebo, was replaced by resistant Klebsiella spp. and Pseudomonas spp. during nitrofurantoin. The carriage of these resi stant organisms tripled during nitrofurantoin. Symptomatic infection d ropped in half on nitrofurantoin, but this decline was due solely to i nfections caused by E. coli. Despite an increased frequency of resista nt organisms on nitrofurantoin prophylaxis, an increase in urinary tra ct infections caused by these resistant organisms did not occur. Concl usion: Routine use of nitrofurantoin prophylaxis in an attempt to erad icate bacteriuria in patients with chronic neurogenic bladder is not e ffective.