Ta. Schlager et al., NITROFURANTOIN PROPHYLAXIS FOR BACTERIURIA AND URINARY-TRACT INFECTION IN CHILDREN WITH NEUROGENIC BLADDER ON INTERMITTENT CATHETERIZATION, The Journal of pediatrics, 132(4), 1998, pp. 704-708
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.