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

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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.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, MedStar Washington Hospital Center, 106 Irving Street NW, Suite 405 South, Washington, DC, 20010, USA

    Feven W. Getaneh & Alexis Dieter

  2. Department of Urology, Ochsner Health, New Orleans, LA, USA

    Rishabh Simhal

  3. Department of Urology, Einstein Health, Philadelphia, PA, USA

    Tamir Sholklapper

  4. Department of Obstetrics and Gynecology, Penn Medicine, Philadelphia, PA, USA

    Emilie Melvin

  5. Georgetown University School of Medicine, Washington, DC, USA

    Charles Scott Dorris

  6. Medstar Health Research Institute, Washington, DC, USA

    Jiling Chou

  7. Department of Obstetrics and Gynecology and Department of Urology, MedStar Georgetown Washington Hospital Center, Washington, DC, USA

    Lee A. Richter

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Contributions

F. Getaneh: data collection, data management, manuscript writing; R. Simhal: protocol development, data collection, data management; T. Sholklapper: protocol development, data collection, manuscript editing; E. Melvin: protocol development, data collection, manuscript editing; C.S. Dorris: protocol development, data collection, manuscript editing; J. Chou: protocol development, data analysis, manuscript editing; L.A. Richter: protocol development, data collection, manuscript editing; A. Dieter: protocol development, data collection, manuscript editing.

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Correspondence to Feven W. Getaneh.

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Getaneh, F.W., Simhal, R., Sholklapper, T. et al. Antibiotic prophylaxis for onabotulinum toxin A injections: systematic review and meta-analysis. Int Urogynecol J 35, 19–29 (2024). https://doi.org/10.1007/s00192-023-05665-4

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  • DOI: https://doi.org/10.1007/s00192-023-05665-4

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