Table 1. Consensus recommendations for UTI prevention in ASB.
| Recommendation | LoE* | GoR* |
|---|---|---|
| 1 Recommendations concerning the use of antibiotics for UTI prophylaxis and treatment | ||
| 1.1 Clinicians should not routinely prescribe long-term prophylactic antibiotics for the prevention of UTI in adults with spina bifida | 2 | B |
| 1.2 Clinicians should not perform routine urine culture surveillance for the prevention of UTI in adults with spina bifida | 2 | B |
| 1.3 Clinicians should not treat asymptomatic bacteriuria for the prevention of UTI in adults with spina bifida | 2 | B |
| 1.4 Clinicians may use intravesical gentamicin instillation for the prevention of UTI in adults with spina bifida | 3 | C |
| 1.5 Early self-start antibiotics for the treatment of UTI in adults with spina bifida | Insufficient evidence | |
| 1.6 Physician-initiated antibiotics for the treatment of UTI in adults with spina bifida | Insufficient evidence | |
| 1.7 The use of immunotherapy for the prevention of UTI in adults with spina bifida | Insufficient evidence | |
| 2 Recommendations concerning the use of supplements | ||
| 2.1 Clinicians should not routinely use cranberry for the prevention of UTIs in adults with spina bifida | 2 | B |
| 2.2 Clinicians should not use methenamine salts (Hiprex) for the prevention of UTIs in adults with spina bifida | 1 | B |
| 2.3 Clinicians should not use ascorbic acid for the prevention of UTIs in adults with spina bifida | 1 | B |
| 2.4 L-methionine for the prevention of UTI in adults with spina bifida | Insufficient evidence | |
| 2.5 Probiotics for the prevention of UTI in adults with spina bifida | Insufficient evidence | |
| 3 Recommendations concerning clean intermittent catheterization (CIC) and indwelling catheter use | ||
| 3.1 Clinicians may use single-use catheters for the prevention of UTIs in adults with spina bifida | 2 | B |
| 3.2 Clinicians may use hydrophilic catheters for the prevention of UTIs in adults with spina bifida | 2 | C |
| 3.3 “No-touch” CIC technique for the prevention of UTIs in adults with spina bifida | Insufficient evidence | |
| 3.4 Clinicians should not recommend sterile catheterization for the prevention of UTIs in adults with spina bifida | 1 | B |
| 3.5 Clinicians should not use silver or antimicrobial coated indwelling catheters for the prevention of UTIs in adults with spina bifida | 1 | B |
| 4 Recommendations concerning bladder factors | ||
| 4.1 Increasing oral fluid intake for the prevention of UTI in adults with spina bifida | Insufficient evidence | |
| 4.2 Clinicians may use saline bladder irrigation for the prevention of UTI in adults with spina bifida doing CIC | 1 | B |
| 4.3 Saline bladder irrigation for the prevention of UTIs in adults with spina bifida using indwelling catheters | Insufficient evidence | |
| 4.4 Anticholinergics for the prevention if UTI in adults with spina bifida | Insufficient evidence | |
| 4.5 Clinicians may use onabotulinumtoxinA intradetrusor therapy for the prevention of UTIs in adults with spina bifida and NB | 3 | C |
| 4.6 Nocturnal emptying for the emptying of UTI in adults with spina bifida | Insufficient evidence | |
| 4.7 Supra-pubic catheter for the prevention of UTI in adults with spina bifida | Insufficient evidence | |
| 4.8 Clinicians may use intravesical hyaluronic acid therapy for the prevention of UTIs in adults with spina bifida | 1 | B |
| 4.9 Bacterial interference is a promising, but not commercially available, therapy for the prevention of UTIs in adults with spina bifida | 1 | B |
| 5 Recommendations concerning provider and social support | ||
| 5.1 The use of structured social support for prevention of UTI in adults with spina bifida | Insufficient evidence | |
| 5.2 Clinicians may use care coordination for the prevention of UTIs in adults with spina bifida | 3 | C |
| 5.3 Clinicians should not use caregiver CIC for the prevention of UTIs in adults with spina bifida | 3 | C |
| 5.4 The use of patient education for prevention of UTI in adults with spina bifida | Insufficient evidence | |
*, scored according to Oxford Level of Evidence (LoE) and Grade of Recommendation (GoR). UTI, urinary tract infection; ASB, adults with spina bifida; NB, neurogenic bladder.