Antibiotic prophylaxis for Botox for idiopathic OAB: practice patterns among FPMRS physicians

Objectives: We aimed to describe the national practice patterns of antibiotic prophylaxis for patients receiving botulinum toxin (BTX-A) injection for idiopathic overactive bladder, and to identify what factors might be associated with prescribing habits.

Methods: We conducted a survey of members of the American Urogynecologic Society (AUGS) and the Society of Urodynamics and Female Pelvic Medicine and Urogenital Reconstruction (SUFU) on their prescribing habits regarding antibiotic prophylaxis for intradetrusor BTX-A to treat idiopathic overactive bladder. Members were contacted via each society’s respective listserv with a link to a REDCap survey in the summer of 2022. Anonymous surveys were collected until October 18, 2022.

Results: We received a total of 312 responses. 220 (70.5%) were gynecologists, 91 (29.2%) were urologists and 1 participant did not specify. Responses include: 247 (79.1%) routinely prescribe antibiotic prophylaxis, 41 (13.1%) do not routinely prescribe antibiotic prophylaxis, and 24 (7.69%) have variable prescription practices. Gynecologists more commonly prescribe antibiotics than urologists (83.6% v 68.1%) (p=0.009). The most common first-choice antibiotic among respondents was nitrofurantoin, followed by trimethoprim-sulfamethoxazole (TMP-SMX) and fluroquinolones. Gynecologists most commonly chose nitrofurantoin (43.8%), while urologists most commonly chose TMP-SMX (29.7%) (p=0.0006). A slight majority of participants prescribe multi-day course (54.1%) versus a one-day course (42.9%), with gynecologists more likely to give a multi-day course than urologists (61.8% v. 35.2%) (p= < 0.0001). Gynecologists are also more likely to start prophylaxis one or more day prior to injection than urologists (p=0.0003). Low volume practitioners ( < 50 injections per year) are more likely to give multiple days of prophylaxis (60.1% v. 43.1%) (p=0.005), but injection volume was not associated with whether prophylaxis was given (p=0.40). Participants located in the Western U.S. were least likely to prescribe antibiotics one or more days prior to injection (p=0.01). Fellowship-training status or years of experience was not associated with any outcome. Routine use of urinalysis was not associated with antibiotic prescribing or duration of prescription.

Conclusions: There are specialty-specific and regional trends in antibiotic prescribing practices for BTX-A used to treat idiopathic overactive bladder. Procedure volume is also associated with duration of antibiotic use. Further research is required to guide best practices in the age of antibiotic stewardship.