Dow et al. 2004
USA
PEDro=10
RCT
Initial N=60; Final N=52

Population: SCI with bacteriuria: Mean age = 39 yrs; Gender: males = 51, females = 9; Level of injury: paraplegia, tetraplegia; Time since injury = 7.1 yrs; Bladder management: intermittent catheterization = 50, condom drainage = 10.
Treatment: Comparison of oral ciprofloxacin (250mg) bid for 14 days vs oral ciprofloxacin (250mg) bid for 3 days followed by 11days of placebo.
Outcome Measures: Urinalysis with leukocyte count, urine culture and surveillance cultures (defined microbiological cure); and type and duration of symptoms (defined clinical cure). All were taken before and at 3-5, 12-16, 19-23 days (defined as short term follow-up) and at 45-51 days (defined as long-term follow-up).

• Higher microbiological cure rates for 14 day vs 3 day treatment at long-term (p=0.02) but not short-term (p=0.29) follow-up. 
• No difference in clinical cure rate between14 day vs 3 day treatment at long-term (p=1.0) or short-term (p=0.6) follow-up.
• Lower rates of clinical & microbiological relapse at short (p=0.001) & long term (p=0.01) follow-up for the 14 day treatment.
• Trend for higher treatment failure rate for 14 day treatment at short (p=0.07) & long term (p=0.07) follow-up largely due to greater number of cipro-resistant isolates in this treatment arm (especially E. faecalis).

Reid et al. 2000
Canada
PEDro=8
RCT
N=42

Population: SCI with symptomatic UTI; Age = 18-75 yrs; Gender: males = 28, females = 14; Level of injury: paraplegia, tetraplegia.
Treatment: Comparison of ofloxacin ( 300 mg bid) vs trimethoprim-sulphamethoxazole (TMPSMX - 160/800 mg bid) or another antibiotic if resistant to TMPSMX for 7 days.
Outcome Measures: Bacteriuria (culture), biofilm presence (# of bacteria / epithelial cell) collected on day 1, 4 or 7.

• Clinical cure rate in favour of Ofloxacin vs TMPSMX or other antibiotic at day 4 (p=.003) and day 7 (p=.015).
• Biofilm clearance rate was better with Ofloxacin vs TMPSMX or other antibiotic at day 4 (p=.005); and day 7 (p=.014);
• Both treatments effective at reducing bacterial biofilms at day 4 and 7 (p<.001).

Sapico et al. 1980
USA
PEDro=6
RCT
N=29

Population: SCI with asymptomatic UTI: Mean age across groups: 21- 32 years old. Bladder Hyperreflexia (n=22), Bladder Hypotonic (n=7);
Treatment: Comparison of standard and low-dose tobramycin (1 mg/kg and 0.5 mg/kg IM every 8 hours) and amikacin (500 mg and 250 mg bid) for 5 days.
Outcome Measures: UTI rate (culture) classified as persistence, relapse or reinfection with other bacteria; Urine and serum antibiotic levels. Cultures conducted prior and 2 and 4 days after treatment completion.

• No significant differences (p>0.05 between dose strengths or tobramycin and amikacin.
• Overall there was a low cure rate of 48% with significant relapse (31%) and reinfection (21%) rates.
• High urine antibiotic concentrations were found in all subjects.
• Authors suggested tobramycin and amikacin not recommended for use in SCI.

Waites et al. 1991
USA
Downs & Black score=12
Pre-post
N=78/69

Population: SCI with UTI susceptible to norfloxacin: Age = 18-69 yrs; Gender: males = 66, females = 3; Severity of injury: complete = 58, incomplete = 11; Time since injury: <6 mths = 5, >/= 6mths = 64.
Treatment: Oral norfloxacin 400 mg bid for 14 days after initial bacteriologic confirmation of UTI.
Outcome Measures: Bacterial strain/species identification, culture results collected at 2-4 days after initiating and 5-7 days and 8-12 weeks after completing treatment.

• 58/79 (73%) negative for UTI mid-treatment at day 2-4.
• 5 to 7 days after administration of norfloxacin, infection was eradicated in 42 cases (53%) while 37 cases (47%) had evidence of infection (>/=105 cfu/mL).
• 8-12 wks after administration, 84% (27/32) were infected after previous eradication (either reinfection or relapse).
• Of 20 species initially identified, 14 were completely eradicated and remaining 6 had >50% eradication.
• Of 120 strains identified during or after treatment, 20 (16%) were resistant to norfloxacin.
• Clinical cure in 67% symptomatic UTIs
• Side effects in 8% of patients.

Linsenmeyer et al. 1999 USA
Downs & Black score=10
Case Series
N=10

Population: SCI with indwelling catheter and asymptomatic bacteriuria resistant to oral antibiotics: Gender: males = 7, females = 3; Level of injury: paraplegia, tetraplegia; Severity of injury: AIS: A, B, D.
Treatment: Bladder irrigation with 30 cc of neomycin/polymyxin solution 3 x with each session (3 session/day for 5 days).
Outcome Measures: Urine culture (type, count and sensitivity) collected pre and post irrigation.

• 9 of 12 bladder irrigation trials across 10 individuals led to changed resistance (resistant à susceptible) allowing use of an oral antibiotic.
• The remaining 3 bladder irrigations were not successful.
• No change in WBCs with irrigation (p>0.05).
• No change in bacterial colony count with irrigation (p>0.05).