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There is insufficient evidence to support a recommendation either in favour of or against the replacement of catheters before antimicrobial treatment as a strategy to prevent CA-UTI. However, while evidence is lacking, this is acknowledged to be current practice and there are theoretical reasons for doing so.
Management of CA-UTI with antibiotics is the approach currently used in clinical practice with antibiotic choice informed by local guidelines that are based on guidance from NICE27 and IDSA.124
For patients with catheters, broader-spectrum treatment is recommended in local health board guidelines and these patients would routinely have a urine sample taken for culture and sensitivity testing to ensure empirical treatment is appropriate.
Do not routinely prescribe antibiotics to prevent UTI in patients using intermittent self catheterisation for bladder emptying. Consider only after full discussion of the benefits and harms likely to apply to the individual.
No evidence was identified on pharmacological non-antimicrobial management of CA-UTI.
Evidence - See section 6.2 in full guideline