ANTIBIOTIC PROPHYLAXIS IN LONG TERM URETHRAL CATHETERISATION?

Routine cephalexin in asymptomatic patients has no apparent benefit Urethral catheters remaining in place for long periods are invariably associated with bacteriuria. There have been few trials evaluating the prophylactic treatment of patients with such in-dwelling catheters. 17 patients received cephalexin 250mg every 6 hours for I 0 days when a susceptible organism was present in the urine, and these patients were compared with a similar control group of 18 patients. The treated group received 160 cepha1exin courses and were observed for 545 patient-weeks compared with 477 patient-weeks for the control group. There was no difference between the groups with regard to incidence and prevalence of bacteriuria, number of bacterial isolates per specimen, number of febrile days, or incidence of obstructed catheters. The frequency of fever was similar whether antibiotics were being used or not. There were more episodes of bacteriuria caused by highly resistant organisms in the cephalexin group than in the controls: 162 episodes ( 4 7%) vs 77 episodes (26% ). Resistant organisms included Pseudomonas aeruginosa, Providencia stuartii and Morganella morganii. Six courses of non-protocol antibiotics were given to the cephalexin group compared with 22 in the control group. 'Routine cephalexin therapy in the afebrile, long-term catheterized patient, even with susceptible bacteriuria, does not seem to be warranted.' Warren, J.W. et al.: Journal of the American Medical Association 248: 454 (23-30 Jul 1982)

0156-2703/82/0703-0003/0$01.00/0 © ADIS Press INPHARMA 21 Aug 1982 11