Treating preoperative bacteriuria
If bacteriuria is confirmed by screening, treat with a short course of antibiotics even if the patient is asymptomatic. For suggested regimens, see Acute cystitis in adults and Acute cystitis in children; use the results of culture and susceptibility testing to choose the most appropriate regimen. Alternatively, treat with a single preoperative dose of gentamicin (as below).
For patients with chronic infection of the urinary tract, results of culture and susceptibility testing should guide antibiotic choice—seek expert advice. It may not be possible to eradicate infection preoperatively and the goal of antibiotic therapy is to minimise bacterial load at the time of surgery.
If an immediate operation is required and there is clinical evidence of a urinary tract infection but culture results are unavailable, treat with a single dose of gentamicin (unless it is contraindicated; see Contraindications and precautions to gentamicin for surgical prophylaxis). A preoperative dose of gentamicin may also be used for patients with confirmed bacteriuria before an elective procedure. Use:
gentamicin (adult and child) 3 mg/kg up to 280 mg intravenously over 3 to 5 minutes, as a single preoperative dose12. surgical prophylaxis, urological, preoperative bacteriuria gentamicin
Gentamicin is concentrated in the urinary tract, so a dose of 3 mg/kg is used to treat acute cystitis or asymptomatic bacteriuria before urological procedures. However, if systemic symptoms are present (eg severe pyelonephritis) a higher dose of gentamicin is needed; see Principles of aminoglycoside use for dosage.
In patients treated with gentamicin preoperatively in whom urinary tract infection is confirmed, use the results of culture and susceptibility testing to choose the most appropriate regimen for ongoing treatment. For suggested regimens, see Acute cystitis in adults and Acute cystitis in children.