Use of Prophylactic Antibiotic In Micturating Cystourethrography: Intramuscular vs Oral and Impact on Patients’ Stress

Abstract

Introduction:

Our centre has been practicing pre-procedural single dose of intramuscular(IM) gentamicin as Urinary Tract Infection(UTI) prophylaxis for Micturating Cystourethrography(MCUG).

Objectives:

• Primary: Quality assurance project to compare oral trimethoprim to IM gentamicin in reducing MCUG-related stress score
• Secondary: Evaluate the risk of post-procedural UTI(ppUTI) in each group, family preference of antibiotic administration and adherence to antibiotic prophylaxis.

Method:

This study conduct in two phases, each lasted 9 months. First phase patients received single dose IM gentamicin prior to MCUG except patients with eGFR< 60ml/min/1.73m2 to receive oral trimethoprim. Second phase patients received 3 days of oral trimethoprim started day before the procedure. Preferences type of antibiotic prophylaxis and stress scores of having respective antibiotic were recorded after the procedure. They were followed up with phone interview at one week and later in clinic.

Result:

56 patients were recruited. (IM gentamicin, n=17, oral trimethoprim, n=39). The median age was 9 months (4 days–14 years).

Mean stress score of IM gentamicin group was 3.9, oral trimethoprim group recorded 0. (p =0.000)

Three oral trimethoprim users (7.89%) developed ppUTI, none from IM gentamicin group. (p =0.244). All 3 were younger than 3 months.

Ninety percent of the patients preferred oral trimethoprim. The oral trimethoprim group reported a full adherence. The positive pick-up rate of urinary tract anomaly from MCUG was 34%.

Conclusion:

Oral trimethoprim significantly alleviates the stress of the procedure with excellent family adherence and family preference. Oral trimethoprim should be choice of antibiotic prophylaxis for children > 3 months old.