Prophylactic Gentamicin with Urinary Catheter Change is Not Recommended
Prophylactic gentamicin should not be administered during routine urinary catheter changes as there is no evidence supporting this practice and it may contribute to antimicrobial resistance. 1
Evidence Against Prophylactic Antibiotics During Catheter Changes
The Infectious Diseases Society of America (IDSA) provides clear guidance on this issue:
- Prophylactic antimicrobials should not be administered routinely to patients at the time of catheter placement, removal, or replacement to reduce catheter-associated bacteriuria or UTI 1
- This recommendation is supported by strong evidence (A-I for catheter placement, B-I for catheter removal, A-III for catheter replacement) 1
- There is insufficient data to suggest that prophylactic antimicrobials reduce bacteremia during catheter changes 1
Risks of Prophylactic Antibiotics
Using prophylactic antibiotics like gentamicin during catheter changes carries significant risks:
- Promotes antimicrobial resistance 1, 2
- Increases risk of adverse drug reactions 2
- Raises risk of Clostridioides difficile infection 2
- May mask symptoms of other underlying problems 2
- Does not appear to reduce mortality or improve outcomes in catheterized patients 1
Current Practice vs. Evidence-Based Recommendations
Despite the lack of evidence supporting its use, an audit revealed that prophylactic antibiotics (usually gentamicin) were given in 60% of catheter procedures in one healthcare trust 3. This highlights the gap between evidence-based recommendations and current practice.
Appropriate Catheter Management to Prevent Infection
Instead of using prophylactic antibiotics, the following strategies are recommended to prevent catheter-associated UTIs:
- Use proper aseptic technique during catheter insertion 2
- Maintain a properly functioning closed drainage system 1, 2
- Minimize disconnection of the catheter junction 1
- Keep the drainage bag and connecting tube below bladder level 1
- Consider using a preconnected catheter system 1
- Remove catheters as soon as they are no longer needed 2
- Perform daily assessment of the need for continued catheterization 2
Special Considerations
For patients with recurrent UTIs who use intermittent catheterization, intravesical gentamicin instillations (not systemic gentamicin) may be considered as an alternative therapy when other treatments have failed 4, 5, 6. However, this is different from prophylactic systemic gentamicin during catheter changes and is considered an off-label use.
When Antibiotics May Be Appropriate
Prophylactic antibiotics during catheterization may only be considered in select high-risk patients:
- Immunocompromised patients
- Patients with recurrent UTIs
- Patients with uncontrolled diabetes
- History of infected renal stones
- Patients undergoing complex urological surgery with extensive instrumentation 2
For these specific high-risk populations, decisions should be made based on individual risk factors and local antimicrobial resistance patterns.