- There are no large randomised control studies to demonstrate long term efficacy for the management of chronic urinary tract infections using bladder instillations.
- Studies relating to patients without neurogenic bladder problems or those who have undergone renal surgery focus on the replenishment of the GAG layer in the bladder. The European Urological Association noted:“A recent review of 27 clinical studies concluded that large-scale trials are urgently needed to assess the benefit of this type of therapy. Therefore, no general recommendation is possible at this stage”. This Cochrane Review published in 2016 confirms these findings.
- There are no standardised treatment regimes – instillations in trials have been offered daily for a week, every third day or once a week
- Antibiotics used in instillations are often generic medications (rather than those that are exclusively patented) thus no pharmaceutical manufacturing company has carried out its own trials on generic antibiotics used in instillations. This means that clinicians often have to develop their own treatment regimes – you may come across the words “rescue instills” which can include not only an antibiotic but also a steroid and gag layer replenishment agent.
- It is invasive which makes it logistically awkward and adds to the treatment expense offered to patients by local clinical commissioning groups and hospitals
- The usage of catheters may introduce further bacteria into an infected bladder
