Intravesical gentamicin protocol - Royal Devon & Exeter Hospital

3. TREATMENT PROTOCOL (ADAPTED FROM SOUTHMEAD)3.1 Patient selection3.1.1 This protocol is for use in patients who have an intact bladder, a bladder augmentedwith, or replaced by, a bowel segment, and for those with an illeal conduit, who sufferrepeated, difficult to treat, urinary tract infections i.e. ≥6 proven urinary tract infectionsin any 12 month period, or at least 1 infection requiring hospital admission in any 12month period with a background of recurrent urinary tract infections. These patientsmay have failed on long-term oral antibiotic prophylaxis or be intolerant to the oralagents currently available for this indication.3.1.2 This protocol should only be used when all conventional measures to reduce thefrequency of urinary tract infections have failed – including a trial of long-term, lowdose antibiotic prophylaxis; use of cranberry juice or capsules; high fluid intake andfrequent voiding; and a check of intermittent self-catheterisation technique whereapplicable.3.1.3 The patient should be made aware by the clinicians responsible for ongoing care thatthe treatment is of unproven benefit and has not been subjected to detailed research.They should then take part in a full discussion and decide for themselves whetherthey want to use this novel treatment. This discussion must be documented in thepatient’s medical notes along with the patient’s consent if they decide to proceed.3.1.4 The patient’s technique in performing intermittent self catheterisation should bechecked and found to be satisfactory. If not already able to self catheterize or iftechnique is poor, patients must be taught self catheterisation technique by a urologyspecialist nurse.3.2 Prescribing and supply3.2.1 Prescriptions are to be issued by Urology Consultants only – either on a hospitaloutpatient script or on a CDM discharge letter. Initially one months supply will beissued followed by three monthly instalments in the absence of complications.3.2.2 Gentamicin 80mg/2mls injection (for intravesical use) should be prescribed inmultiples of five = thirty amps/month. Sodium chloride 0.9% 20ml ampoules shouldbe prescribed in multiples of 20 (remember 3 ampoules will be required per dose) =100ampules/month.3.2.3 The first prescription must be accompanied by an intravesical gentamicin prescriptionauthorisation form as this is an unlicensed, novel indication for gentamicin (seeappendix 3). The completed form will be kept in Pharmacy for reference againstfuture supplies.3.2.4 Equipment to facilitate intravesical administration will initially be provided by thespecialist nurse (for up to one month) and the patient’s GP will prescribe subsequentsupplies – this may include the sodium chloride 0.9% at the discretion of the GP.3.3 Method of administration and duration of therapy3.3.1 Gentamicin 80mg diluted in 50ml of sterile sodium chloride 0.9% should be instilled inthe bladder nightly, after completion of a conventional bladder washout, and thecatheter withdrawn, leaving the solution in the bladder overnight.3.3.2 The solution will be voided spontaneously in the morning, or be removed by routineself catheterisation.3.3.3 Therapy is intended to be life-long in the absence of complications or a change incircumstances.INTRAVESICAL GENTAMICIN GUIDELINEApproved by the Drug and Therapeutics Committee: 21 st June 2011Review date: June 2012Page 3 of 7