title: A pilot randomized double-blind placebo-controlled trial on the use of antibiotics on urinary catheter removal to reduce the rate of urinary tract infection: the pitfalls of ciprofloxacin.
abstract: OBJECTIVE
  To assess if a short course of antibiotics starting at the time of the removing a short-term urethral catheter decreases the incidence of subsequent urinary tract infection (UTI).
  
  
  METHODS
  Patients across specialities with a urethral catheter in situ for >/= 48 h and </= 7 days were recruited at the time of catheter removal. Patients were excluded if they had had recent genitourinary surgery or were on antibiotics. Eligible patients were randomly assigned to a 48-h course of either ciprofloxacin or placebo tablets starting 2 h before catheter removal. A catheter specimen of urine was obtained before the start of the trial medication. The follow-up was at 7 and 14 days after catheter removal, with a questionnaire for UTI symptoms, and a mid-stream urine sample was taken.
  
  
  RESULTS
  Forty-eight patients were recruited and had a complete follow-up (25 received ciprofloxacin and 23 placebo). Of the ciprofloxacin group, four patients (16%) had a UTI at the follow-up after catheter removal, and two were symptomatic. The UTI in two patients (including one of those symptomatic) was newly developed after catheter removal; the other two UTIs were a result of failure to resolve a catheter-associated UTI. All these UTIs in the ciprofloxacin group were resistant to ciprofloxacin. Of the placebo group, three patients (13%) had a UTI at the follow-up after removal, and one patient was symptomatic. The UTI, newly developed after catheter removal, was resistant to ciprofloxacin. The other two patients were asymptomatic; their UTIs were a result of failure to resolve a catheter-associated UTI, and one was resistant to ciprofloxacin.
  
  
  CONCLUSIONS
  The risk of UTI (both symptomatic and asymptomatic) after removing a urethral catheter is real, even in absence of catheter-associated UTI before removal. UTIs occurring after removing a short-term urinary catheter had a high rate of resistance to ciprofloxacin. There was no detectable significant benefit in using prophylactic ciprofloxacin to reduce the UTI rate after catheter removal.
authors.affiliation: Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK. hwazait@hotmail.com
authors.forename: Hassan D
authors.initials: HD
authors.lastname: Wazait
authors.forename: Hitenddra R
authors.initials: HR
authors.lastname: Patel
authors.forename: Jan H P
authors.initials: JH
authors.lastname: van der Meulen
authors.forename: Maneesh
authors.initials: M
authors.lastname: Ghei
authors.forename: Salah
authors.initials: S
authors.lastname: Al-Buheissi
authors.forename: Michael
authors.initials: M
authors.lastname: Kelsey
authors.forename: Ronald A
authors.initials: RA
authors.lastname: Miller
authors.forename: Mark
authors.initials: M
authors.lastname: Emberton
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D002939:Ciprofloxacin / Q000627:therapeutic use*; D020878:Device Removal; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D014546:Urinary Catheterization; D014552:Urinary Tract Infections / Q000517:prevention & control*
chemical_list: D000890:Anti-Infective Agents; D002939:Ciprofloxacin