VESPER

Intravesical preparations for recurrent urinary tract infection prevention (the VESPER trial): a multi-arm, multi-site open label randomised superiority trial.

The VESPER trial will compare two treatments given directly into the bladder to prevent UTI against the current recommended treatment of daily oral second-line antibiotics. For this trial, women seen in a hospital urology/urogynaecology clinic with rUTI who have not improved after first-line antibiotic treatment will be invited to take part. The treatment given to each participant will be decided randomly by a computer and will be either:

1. Gentamicin, an antibiotic, given periodically into the bladder over 6-months
2. Glycosaminoglycan (GAG) replacement preparations given periodically into the bladder over 6-months -this repairs the damaged lining of the bladder to prevent bacteria from attaching to it.
3. Daily low-dose, second-line oral antibiotic treatment for 6 months as recommended by National Institute for Health and Care Excellence (NICE) guidelines (STANDARD CARE).

We will compare the number of UTI episodes occurring in each group during the 6-months of treatment to see which of the three treatments is best at preventing UTI. We will follow-up each woman during and after treatment and record the number of UTIs women have as well as looking for other benefits, side effects and costs of treatment. We will also record the types of bacteria found in UTIs and their resistance to antibiotics.