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