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Thread: Tobramycin bladder irrigation

  1. #1

    Tobramycin bladder irrigation

    So over the past 4 years I've been getting a lot of utis to the point now where i get one every like 2 weeks. So my general doctor has prescribed tobramycin for bladder irrigation once daily. But i don't really know how to do it? I in and out cath with a normal catheter every 3-4 hours. Has anyone else tried tobramycin for daily bladder irrigation? Do i just cath get all the urine i can out and then put a new catheter in and inject the stuff? And How long am i supposed to leave it in there?
    Its only at the brink of our own destruction that we learn to change.

  2. #2
    Do you have a urologist? This is way beyond the expertise of a general doctor. How can they prescribe something when they don't even understand how to do it!?

    I haven't heard of using this antibiotic for bladder instillation before. But my Dad starting doing Gentamicin instillations twice a day, 8 months ago for his recurrent UTIs. His urologist is an expert in SCI/neurogenic bladder. My Dad caths every 3-4 hrs during the day.

    So he does his usual morning cath. After the urine drains out, he keeps the catheter in place. He wipes the funnel/draining end of the catheter with an alcohol swab. Then he grabs a 60cc "catheter tip' syringe with gentamicin in it and inserts it carefully in the funnel end of his catheter. Then he carefully pushes the syringe plunger... injecting the antibiotic through the catheter and into his bladder. When he is done, he disconnects the syringe and disposes it. Then he carefully removes the catheter. He lays down and rolls around a little so the antibiotic coats his bladder wall. He leaves the Gentamicin in there until his next catheterization.

    Pretty simple, actually, but takes a little time to get the hang of it. His pharmacy fills syringes with Gentamicin and delivers them once a week, which he keeps in a fridge. He takes out a syringe to warm a little bit before doing the instillation. But he often instills it while it is still "cold".

    I hope the doctor at least set up the deliveries of your Tobramycin for you, and you know how much to inject in each day.

  3. #3
    I do have a urologist but my General doctor does prescribe my antibiotics when i get a bladder infection and it just so happens my general doctor one of his patients is my old urologoist. Ideally he would still be my urologist because he is very good but he's a pediatric urologist so i have new urologist. So i guess they were having a conversation because my general doctor wanted to know how we can stop these bladder infections and they came up with solution. It does tell how much to inject and those instructions are very helpful thank you. Did it stop your father from having frequent utis? I am also going to try and book an appointment for my old urologist.
    Its only at the brink of our own destruction that we learn to change.

  4. #4
    Senior Member
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    I've not used it myself but recently read an article in New Mobility about Neosporin Gu being used to treat uti infections as a irrigant.

  5. #5
    Yes, it has stopped my Dad's UTIs. None for 8 months. He will continue to do the instillations for now, and will probably decrease to once a day and then maybe try stopping in the future.... there's no right/wrong here. My Dad is a little unusual though, as he is older (73) and he has some immune system problems that also increase his risk of getting infections. This is why his doctors want to be fairly aggressive with trying to prevent more infections. He gets very sick, fast.

    Well, that's nice how your primary care doc talked to your old urologist. Small world....

  6. #6
    I couldn't find research for UTI prevention but Urology puts in fluid bag used for cystoscope sand uro dynamics as a preventative measure. CWO

  7. #7
    Senior Member ChesBay's Avatar
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    Quote Originally Posted by Brent K View Post
    I've not used it myself but recently read an article in New Mobility about Neosporin Gu being used to treat uti infections as a irrigant.
    Irrigation / instillation has greatly reduced a cycle of recurring UTIs I was experiencing a few years back. do instillation every night as described in New Mobility article every night for approx 6- 7 years, has made a tremendous difference in quality of life and preventing UTIs. PM me if you have questions.

    Previous post / thread :
    "For the last few years this procedure has broken a recurring UTI cycle I was in and reduced by about 80 % annually. ( I instill 60cc's the article discusses 40 cc's)

    New Mobility 2011 article:

    http://www.newmobility.com/2011/04/neosporin-gu/ "

    8/15 thread :
    http://sci.rutgers.edu/forum/showthr...87#post1777087

  8. #8
    Quote Originally Posted by hlh View Post
    Yes, it has stopped my Dad's UTIs. None for 8 months. He will continue to do the instillations for now, and will probably decrease to once a day and then maybe try stopping in the future.... there's no right/wrong here. My Dad is a little unusual though, as he is older (73) and he has some immune system problems that also increase his risk of getting infections. This is why his doctors want to be fairly aggressive with trying to prevent more infections. He gets very sick, fast.
    .
    hlh thank you for the description your Dad's experience .
    do I understand correctly you're not preparing the solution but getting it in ready to use syringe? That means one-time-used syringe? So, you don't know how to clean the syringe if use it few times?
    Also when doing selfcath and urine stop running the catheter has about 5-10 ml urine in it. So, when instilling Gentamicin/w normal saline solution, you first insert that urine from the catheter back to the bladder?
    i'm in desperate need to start those instillations, so thank you in advance for your answers.

  9. #9
    My Dad gets his Gentamicin from Walgreens Infusion pharmacy. This is not the Walgreens stores in the community, but a separate entity that provides home IV antibiotics and other medications. Just look online and call them or ask the doctor who writes the script if there is a pharmacy they work with or one at the hospital/clinic that can prepare it. I just faxed the script to them, and they prepare the Gentamicin solution and deliver it directly to my Dad's house each week. The stability is not very long (you keep it in the fridge), so they send only 1 weeks worth at a time.

    Initially, my father received a large bottle of the Gentamicin from the pharmacy that was already prepared to the concentration that his urologist ordered. We bought some 60cc syringes of the correct type (I think the cheapest was on a vet/animal website!) and a small measuring cup. We would pour about 60cc into the measuring cup and then draw it up into the syringe. Or I would try to insert the syringe into the bottle (carefully....) and draw up the amount. That didn't work very well..... Be as clean as you can. We'd let it warm a bit to room temperature so that it wasn't completely cold when my Dad would use it.

    I just washed the syringe and cup in soap and water initially and reused them. Honestly, I looked on this website to see what other people were doing. We also had a lot of syringes initially, so I would also use a new one a lot.

    But then the pharmacist who prepares the Gentamicin said they could provide it already loaded in the syringes. His insurance covers everything, and the syringes were quite cheap anyway this way. It is also easier for my Dad to be independent this way.

    Honestly, his doctor gave him no detailed instructions how to do it at all. "Just cath.... inject in the Gent... remove the catheter". Thanks for that detailed advice!

    I wouldn't worry about the urine left over in the catheter getting injected back into the bladder. It is a small volume, and will be mixed with antibiotic.

    Good luck. Let us know if it works for you.

  10. #10
    I am currently consulting with 2 urologists and Both of them gave me two options prophylactic antibiotic one said used trimethidrim other macrodantin low dose then if that doesn't work go to gentamycin instillation I am leaning towards instillation right away. Glad to see specifics as i didn't know how to go about it. With 8 infections in 10 months with a variety of bugs I have to try something. Anyway glad for the input.

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