title: Safety of gentamicin bladder irrigations in complex urological cases.
abstract: OBJECTIVE
  Recurrent urinary tract infections are common in complex pediatric urological cases, particularly those requiring clean intermittent catheterization. At our institution gentamicin bladder irrigations have been used for antimicrobial prophylaxis and to treat symptomatic bacteriuria, particularly when the infection does not involve the upper urinary tract. The purpose of this study was to assess the safety of this therapy.
  
  
  METHODS
  A retrospective study was performed of all children treated with gentamicin bladder irrigations from 1999 to 2004. The dose was 14 mg gentamicin in 30 ml saline instilled via catheter once or twice daily. Serum creatinine and random gentamicin levels were obtained according to a protocol based on risk of gentamicin toxicity. Patient demographics, laboratory results and outcomes were abstracted from the medical records.
  
  
  RESULTS
  A total of 80 patients (38 males and 42 females) were identified. Median patient age was 10 years and median duration of treatment was 90 days. No patient had detectable serum gentamicin levels greater than 0.4 mg/dl. Small increases in serum creatinine were seen in 3 patients, all of whom had chronic renal insufficiency. A total of 21 patients (26%) had breakthrough UTIs, of which 5 (24%) were gentamicin resistant. No adverse events were documented.
  
  
  CONCLUSIONS
  Gentamicin bladder irrigations are a helpful adjunct in the management of complex pediatric urological cases involving recurrent symptomatic bacteriuria. We no longer require intensive laboratory monitoring of low risk patients at our institution.
authors.affiliation: Division of Pediatric Urology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229-3039, USA. bob.defoor@cchmc.org
authors.forename: William
authors.initials: W
authors.lastname: Defoor
authors.forename: Denise
authors.initials: D
authors.lastname: Ferguson
authors.forename: Susan
authors.initials: S
authors.lastname: Mashni
authors.forename: Lisa
authors.initials: L
authors.lastname: Creelman
authors.forename: Deborah
authors.initials: D
authors.lastname: Reeves
authors.forename: Eugene
authors.initials: E
authors.lastname: Minevich
authors.forename: Pramod
authors.initials: P
authors.lastname: Reddy
authors.forename: Curtis
authors.initials: C
authors.lastname: Sheldon
mesh_terms: D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005839:Gentamicins / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D007223:Infant; D008297:Male; D011996:Records; D012189:Retrospective Studies; D012449:Safety; D007507:Therapeutic Irrigation; D014552:Urinary Tract Infections / Q000188:drug therapy*
chemical_list: D000900:Anti-Bacterial Agents; D005839:Gentamicins