INtravesical Antimicrobial Agents v STANDard Oral Antibiotics for the Treatment of Acute UTI in Women With rUTI

Each participant once enrolled returns with an active Urinary Tract Infection (UTI), confirmed by urine void. Participants will complete an UTI questionnaire, and if consistent with a simple non-febrile UTI will be randomized to one of two arms: oral nitrofurantoin treatment for 7 days, or intravesical gentamicin instillation once a day for three days. Patients will be followed for symptom relief with a repeat voided urine in 7 to 10 days, and with a repeated questionnaire for symptom relief.

• Nitrofurantoin (Drug), also known as Macrobid, Furadantin, Macrodantin: Participants will receive oral Nitrofurantoin 100 mg twice daily for 7 days
• Gentamicin (Drug), also known as Gentak, Garamycin: Participants will receive intravesical via catheter Gentamicin solution 25 mg in 50cc for 3 days

Primary outcomes

• Change in microbiologic effect of a chronic acute Urinary Tract Infection [baseline, 7-10 days]: Microbiological culture growth of susceptible organisms obtained on day 0, compared with voided urine culture as no growth in 24-48 hours obtained at 7-10 days
• Change in symptomatic relief of a chronic acute Urinary Tract Infection [baseline, 7-10 days]: Completion of a Symptom Urinary Tract Questionnaire. Tracking the symptoms in the past 24 hours. Indicating how severe and how bothersome they were. Severe ranging from 0 (Did not have) to 3 (Severe). Bothersome ranging from 0 (Not at all) to 3 (A lot)

Secondary outcomes

• To establish the clinical FTE needs for providing urgent intravesical treatments [baseline, through stufy completion, an average of one year]: Nursing needs to provide intravesical treatments of acute Urinary Tract Infections (UTI) in women with chronic recurrent UTIs. Measured in amount of participants and FTE requirement for nursing staff.

Sex: Female, ages: 18 Years to any

Inclusion Criteria:

* Ability to understand study procedures and to comply with them for the entire length of the study.

Exclusion Criteria:

* Patients who report that they are pregnant.
* Patients with a positive urine pregnancy test
* Patients with a history of renal transplantation.
* Patients with bladder augmentation procedures using bowel.
* Patients with poorly controlled Type II diabetes, Hgb A1C >6.5%
* Patients with spinal cord injury, ASIA Impairment Scale of C or higher.
* Patients with pelvic surgery within 6 months.
* Patients with urologic procedure within 6 months.
* Patients with a history of reconstructive urologic surgery, such as reflux, congenital abnormality.
* Immunocompromised patients being treated for malignancy or a history of actively treated malignancy within 5 years.
* Patients with active systemic autoimmune disease.
* Patients on systemic immunosuppression.
* Use of antibiotic prophylaxis within 6 months
* Use of antibiotics within 10 days of active infection
* Allergy/sensitivity to gentamicin or nitrofurantoin.
* Current drug or alcohol use or dependence that, in the opinion of the site investigator, would interfere with adherence to study requirements.
* Inability or unwillingness of individual to give written informed consent.

• Deborah Lightner, MD, Principal investigator, Mayo Clinic
• Audrey N Schuetz, MD, Principal investigator, Mayo Clinic