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Electronic letters published:
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Nitrofurazone-impregnated Foley catheter
Re: nitrofurantoin systemic effects
nitrofurantoin systemic effects
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James R. Johnson, MD Universtiy of Minnesota; Minneapolis VA Medical Center
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johns007{at}umn.edu James R. Johnson
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To the Editor: In their randomized clinical trial of an antimicrobial-impregnated Foley catheter, Stensballe et al. found a significantly lower frequency of new or changed antimicrobial therapy among recipients of the test catheter, as opposed to the control catheter [1]. The investigators are to be commended for examining this potentially clinically important outcome, since previous such trials have focused only on urine culture results, which are of doubtful clinical significance [2]. However, the applicability of this finding to usual hospital practice is uncertain. Notably, Stensballe et al. fed back their study's daily urine culture results to the patients' physicians, who treated asymptomatic bacteriuria/funguria whenever it was detected, as physicians tend to do [3]. This doubtless generated considerably more antimicrobial therapy than would have occurred had urine cultures been performed only twice weekly (the trauma unit's usual schedule), or for suspected infection (as is done in many acute care settings). Thus, whether an antimicrobial Foley catheter can truly improve clinical practice patterns or patient outcomes during routine use remains to be demonstrated. 1. Stensballe J, Tvede M, Looms, D, Knudsen F, Dahl B, Tonnesen E, Rasmussen LS. Infection risk with nitrofurazone-impregnated urinary catheters in trauma patients. Ann Intern Med. 2007;147:285-93. 2. Johnson JR, Kuskowski MA, Wilt TJ. Systematic review: antimicrobial urinary catheters to prevent catheter-associated urinary tract infection in hospitalized patients. Ann Intern Med. 2006;144:116-26. 3. Tambyah PA, Make DG. Catheter-associated urinary tract infection is rarely symptomatic: a prospective study of 1,497 catheterized patients. Arch Intern Med. 2000;160:678-82. Conflict of Interest:I have received research grants and consultancies from Rochester Medical Corp. (manufacturer of the nitrofurazone-impregnated catheter) |
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Jakob Stensballe, MD, PhD Copenhagen University Hospital, Rigshospitalet. Dep of Anesthesia, Centre of Head and Orthopedics.
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jakob.stensballe{at}rh.regionh.dk Jakob Stensballe
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Dr. Stinnette, thank you for the interest. We found no evident adverse side effects such as anemia, liver or respiratory failure related to the nitrofurazone impregnation of the silicone catheter. This is in accordance with Marion-Landais and colleges’ findings that nitrofurazone is not absorbed to the surrounding tissue or systemically (1). Furthermore, the observed adverse events in the study were found non-related to the nitrofurazone impregnation, more likely related to the procedure of catheterization. 1. Marion-Landais G, Heotis JP, Mertz JL, Diaz JR, Van Hart DC, Newsom JH, et al. Non-absorption of nitrofurazone from the urethra in men. Curr Ther Res Clin Exp. 1976. Conflict of Interest:Unrestricted research grant received from Coloplast A/S |
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William A Stinnette, MD Kaiser Permanente
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bananarat{at}msn.com William A Stinnette
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Any evidence for systemic absorption and associated adverse effects related to nitrofurantoin, such as anemia, liver abnormalities and respiratory difficulties, including lung injury? Conflict of Interest:None declared |
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