Q. I’m in my 20th year as a T9 para. I manage my bladder with intermittent catheterization — I try and drink plenty of water and cath four to five times a day.

For the last three years I’ve been fighting UTIs. Every month or two I’ll get cloudy, smelly urine when I cath, and sometimes this coincides with feeling run down, sure signs I’m getting a UTI. When this happens I drink lots of water and try to flush it out. Sometimes it works, my urine clears up and I feel better. But when things don’t clear up in a day or two I run through another course of ciprofloxacin antibiotic which clears up my urine and makes me feel better, but seriously messes with my digestive tract.

I’m worried that taking antibiotics too often is setting me up for more problems with antibiotic resistance in the future, but I’ve also had a few serious UTIs that landed me in the hospital on IV antibiotics. I’d rather risk taking antibiotics than feel that sick again.

In a previous Bladder Matters column you talked about an antibiotic called Neosporin Gu that could be put directly into the bladder and didn’t have the side effects of an oral antibiotic.

Is this something that can be used on a regular basis? And does it cause antibiotic resistance?

— Mark

A. Mark, your question is timely as you and I fall into a common SCI and UTI scenario and dilemma. Since writing about the prescription mix of Neosporin Gu, (June 2010 Bladder Matters) I started using it, and it has kept me free from UTIs and oral antibiotics.

Paula Wagner, a urology nurse practitioner from U.C. Davis Medical Center in Sacramento, Calif, says that, in general, if you use an intermittent catheter or indwelling catheter and give a urine sample, it will likely come back positive for bacteria.

When to treat a potential UTI with antibiotics is a balancing act. When a UTI gets bad enough to produce symptoms like fever and chills, the bacteria have probably made their way up into the kidneys, which can be very serious and may cause kidney damage. Ideally you want to catch a UTI early and start treating it before it gets to this stage. This often means a physician will prescribe a course of antibiotics at the first onset of a UTI. But every time urine is cloudy or smelly or you feel run down doesn’t mean you are getting a UTI; maybe you are just dehydrated and need to drink more water. You don’t want to over treat potential UTIs because taking antibiotics can cause side effects like you describe, and taking them too often can create antibiotic resistant bugs.

This is why the prescription mix of Neosporin Gu and sterile saline irrigation may be something to ask your physician or urologist about. The solution is made by adding 1 ml of Neomycin-Polymyxin B GU (liquid Neosporin antibiotic) to a 1000 ml (about a quart) bottle of .09% Sodium Chloride (sterile saline) solution. To administer, you pour some of the solution into a sterile cup and draw 40cc into a 60cc irrigation syringe. Do your regular catheterization, and when you are done, leave in the catheter; insert the syringe into the catheter and inject the solution into your bladder; then pull the catheter out and leave the solution in your bladder until the next time you cath. While it’s in there the solution will wipe out any nasty bugs trying to make a stronghold.

People that use an indwelling Foley or suprapubic catheter can use the same solution. Inject 40cc into the indwelling catheter, and clamp the catheter for 30 minutes. Make sure to set an alarm — you never want to leave a urinary tube clamped off for too long, or you could have problems with reflux and/or dysreflexia.

Neosporin Gu antibiotic mix, unlike oral antibiotics, doesn’t affect the stomach or other parts of the body, and it doesn’t create antibiotic resistance.

Wagner says that to be effective it only needs to be used once a day. If that works well you can switch to using it every other day. The solution can also be used in a hit and miss method — when your urine looks clear and you feel fine and don’t feel like using it that is OK. If you notice your urine starts to look cloudy or smell funny you can resume the procedure for a few days until your urine clears up again.

For me this is has been an effective tool to knock back UTIs, or suspected UTIs, when they first start — without the side effects and worry of developing resistant bugs from taking oral antibiotics.

Wagner is quick to add that it is important to remember the first line of defense against UTIs is proper bladder care. This includes staying well hydrated, preferably by drinking plenty of water. A good rule of thumb is to drink enough water that your urine is clear to a mild straw-color. It is also important to catheterize on a regular basis so your volumes are less than 400cc (about 1.7 cups). And since residual urine in the bladder makes it easier for UTIs to make a stronghold, it is important to completely empty your bladder. The opening to the urethra is located at the bottom of the bladder, so the best way to make sure you are completely emptying your bladder is to cath while sitting upright. Also, when a catheter is in the bladder, the eyelets (drain holes) are probably higher than the opening, when urine flow stops, slowly pull the catheter out an inch or two and stop — this will allow urine at the bottom of the bladder to empty. For people who cath while lying down, use the same system of pulling the catheter out a few inches and roll side to side.

Please send questions about bladder health to bladder@newmobility.com.