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 rates of bacteriuria and symptomatic urinary tract infection in children with chronic neurogenic bladder receiving clean intermittent catheterization.


METHODS
Double-blind, placebo-controlled, crossover trial of 15 children receiving nitrofurantoin or placebo for 11 months (5 months 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 drug.


RESULTS
During nitrofurantoin the frequency of bacteriuria remained high. Cultures of 74% (203 of 274) of the 274 samples on placebo were positive for a pathogen (> or = 10(4) colony-forming units per milliliter) compared with 65% (165 of 252) of the 252 samples on nitrofurantoin. The bacterial species responsible for bacteriuria, however, were altered; Escherichia coli, the most common pathogen isolated during placebo, was replaced by resistant Klebsiella spp. and Pseudomonas spp. during nitrofurantoin. The carriage of these resistant organisms tripled during nitrofurantoin. Symptomatic infection dropped in half on nitrofurantoin, but this decline was due solely to infections caused by E. coli. Despite an increased frequency of resistant organisms on nitrofurantoin prophylaxis, an increase in urinary tract infections caused by these resistant organisms did not occur.


CONCLUSIONS
Routine use of nitrofurantoin prophylaxis in an attempt to eradicate bacteriuria in patients with chronic neurogenic bladder is not effective.
Schlager
T A
TA
Department of Pediatrics and Emergency Medicine, University of Virginia, Charlottesville 22906-0014, USA.
Anderson
S
S
Trudell
J
J
Hendley
J O
JO
D000293:Adolescent; D000892:Anti-Infective Agents, Urinary / Q000627:therapeutic use*; D001437:Bacteriuria / Q000382:microbiology / Q000517:prevention & control*; D002648:Child; D002675:Child, Preschool; D018592:Cross-Over Studies; D004311:Double-Blind Method; D004927:Escherichia coli Infections / Q000517:prevention & control; D005260:Female; D006801:Humans; D007223:Infant; D007710:Klebsiella Infections / Q000517:prevention & control; D008297:Male; D008591:Meningomyelocele / Q000150:complications; D009582:Nitrofurantoin / Q000627:therapeutic use*; D011552:Pseudomonas Infections / Q000517:prevention & control; D013997:Time Factors; D001750:Urinary Bladder, Neurogenic / Q000209:etiology / Q000628:therapy*; D014546:Urinary Catheterization / Q000009:adverse effects; D014552:Urinary Tract Infections / Q000382:microbiology / Q000517:prevention & control*
D000892:Anti-Infective Agents, Urinary; D009582:Nitrofurantoin