From the Guidelines
Management of balanitis in a patient with a Foley catheter involves treating the underlying infection while addressing catheter-related factors, with the primary goal of reducing morbidity, mortality, and improving quality of life. The most effective approach is to assess whether the catheter can be removed, as this is often the most effective intervention, considering that catheter removal alone may result in eradication of candiduria in almost 40% of patients 1. If removal is possible, replace it after treatment; if not, consider changing to a new catheter. Key steps in management include:
- Cleaning the affected area thoroughly with warm water and mild soap, avoiding harsh cleansers that may worsen irritation.
- Applying topical antifungal cream (clotrimazole 1% or miconazole 2%) twice daily for 7-10 days if fungal infection is suspected, or topical antibiotics like mupirocin 2% ointment three times daily for 7 days if bacterial infection is present.
- Considering oral fluconazole 150mg as a single dose (fungal) or oral antibiotics like cephalexin 500mg four times daily for 7 days (bacterial) for severe cases. Ensuring proper catheter care with daily cleansing around the insertion site and maintaining good hygiene is crucial, as the catheter itself can be a source of infection and irritation, creating a moist environment conducive to microbial growth, while mechanical friction can exacerbate inflammation 1. Regular assessment of the need for continued catheterization is essential for long-term management, taking into account the potential for catheter-related bloodstream infections and the importance of removing the catheter if there are evident signs of local infection or clinical signs of sepsis.
From the Research
Management of Balanitis in a Patient with a Foley Catheter
- The management of balanitis in a patient with a Foley catheter is crucial to prevent further complications.
- There is limited direct evidence on the management of balanitis in patients with a Foley catheter, but some studies suggest the use of topical antibiotics to prevent urinary tract infections (UTIs) in patients with indwelling catheters 2.
- A study published in 1979 found that continuous vesical irrigation with a mixed antibiotic solution of neomycin and polymyxin B was effective in preventing and treating urinary infections in patients with indwelling catheters 2.
- Another study published in 2019 found that daily neomycin-polymyxin or gentamicin bladder instillations reduced the rate of symptomatic UTIs in patients with neurogenic bladder on clean intermittent catheterization 3.
- However, there is no direct evidence on the use of these antibiotics for the treatment of balanitis in patients with a Foley catheter.
Topical Antibiotics for Balanitis
- Some studies suggest the use of topical antibiotics for the treatment of balanitis, but the evidence is limited.
- A study published in 2020 found that topical antibiotics were effective in improving resolution of ear discharge in patients with chronic suppurative otitis media, but the certainty of the evidence was low 4.
- Another study published in 2008 found that ciprofloxacin otic solution 0.2% was noninferior to polymyxin B-neomycin-hydrocortisone in the treatment of acute diffuse otitis externa 5.
- However, the use of topical antibiotics for the treatment of balanitis in patients with a Foley catheter is not well established.
Safety of Polymyxin B
- Polymyxin B is a topical antibiotic that has been used to treat various infections, including carbapenem-resistant Gram-negative bacterial infections.
- A study published in 2021 found that polymyxin B was effective and safe in the treatment of carbapenem-resistant Gram-negative bacterial infections, with a low rate of nephrotoxicity 6.
- However, the safety of polymyxin B for the treatment of balanitis in patients with a Foley catheter is not well established.