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Meta-Analysis
. 2024 Jan;35(1):19-29.
doi: 10.1007/s00192-023-05665-4. Epub 2023 Nov 8.

Antibiotic prophylaxis for onabotulinum toxin A injections: systematic review and meta-analysis

Feven W Getaneh  1 , Rishabh Simhal  2 , Tamir Sholklapper  3 , Emilie Melvin  4 , Charles Scott Dorris  5 , Jiling Chou  6 , Lee A Richter  7 , Alexis Dieter  8
Affiliations
Meta-Analysis

Antibiotic prophylaxis for onabotulinum toxin A injections: systematic review and meta-analysis

Feven W Getaneh et al. Int Urogynecol J. 2024 Jan.

Abstract

Introduction and hypothesis: To our knowledge, there are no evidence-based recommendations regarding the optimal prophylactic antibiotic regimen for intradetrusor onabotulinum toxin type A (BTX) injections. This systematic review and meta-analysis was aimed at investigating the optimal prophylactic antibiotic regimen to decrease urinary tract infection (UTI) in patients undergoing BTX for overactive bladder syndrome (OAB).

Methods: A systematic search of MEDLINE, Embase, CINAHL, and Web of Science was conducted from inception through 30 June 2022. All randomized controlled trials and prospective trials with > 20 subjects undergoing BTX injections for OAB in adults that described prophylactic antibiotic regimens were included. Meta-analysis performed to assess UTI rates in patients with idiopathic OAB using the inverse variance method for pooling.

Results: A total of 27 studies (9 randomized controlled trials, 18 prospective) were included, representing 2,100 patients (69% women) with 19 studies of idiopathic OAB patients only, 6 of neurogenic only, and 2 including both. No studies directly compared antibiotic regimens for the prevention of UTI. Included studies favor the use of antibiotics in patients with idiopathic OAB and favor continuing antibiotics for 2-3 days after the procedure for prevention of UTI. Given the heterogeneity of the data, direct comparisons of antibiotic type or duration could not be performed. Meta-analysis found a 10% UTI rate at 4 weeks and 15% at 12 weeks post-injection.

Conclusions: Although there are insufficient data to support the use of a specific antibiotic regimen, available studies favor the use of prophylactic antibiotics for 2-3 days in idiopathic OAB patients undergoing BTX injection. Future trials are needed to determine the optimal regimens to prevent UTI in patients undergoing BTX for OAB.

Keywords: Anti-bacterial agents; Botox; Overactive bladder; Systematic review; Urinary tract infection.

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References

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