Adult
Cystoscopic detrusor botulinum prophylaxis
At booking of procedure check:
- Results of any previous measurement of eGFR.
- If no suspicion of renal impairment ensure that there is an eGFR result from the last 6 months.
- If the patient has a history of renal impairment ensure result is within 1 month.
- If appropriate results not available take blood for eGFR.
- Review of previous UTI and associated sensitivities. If resistant organisms identified discuss with Micro/ID
- Cystoscopic detrusor botulinum treatment may cause UTI.
- If the patient has had 2 or more UTIs in the past 6 months or more than 3 UTIs in past 12 months, review with the patient and discuss the appropriateness of continuing botulinum treatment taking the risk and benefit into consideration.
For prescribing use Urogynae (UG) Botulinum PowerPlan on EPR
Preferred including penicillin allergy (non-severe and severe) and eGFR 45mL/min/1.73m2 and over
Doses to be given 1 hour before the procedure once admitted to the unit
nitrofurantoin 100mg po single dose
Adverse effects have been reported with nitrofurantoin see Nitrofurantoin MHRA drug safety updates
Alternative including penicillin allergy (non-severe and severe)
Doses to be given 1 hour before the procedure once admitted to the unit
co-trimoxazole po single dose
| eGFR mL/min/1.73m2 | co-trimoxazole po dosing |
| 31 -44 | 960mg |
| 15 - 30 | 480mg |
For eGFR less than 15 mL/min/1.73m2: Discuss with Urogyanecology MDT team
Culture and/or sensitivity suggest resistant to nitrofurantoin and co-trimoxazole:
Contact Micro/ID who may recommend fosfomycin 3g po single dose (if eGFR mL/min/1.73m2 is 10 or greater)