Addition of Ceftriaxone and Amikacin to a Ciprofloxacin plus Metronidazole Regimen for Preventing Infectious Complications of Transrectal Ultrasound-Guided Prostate Biopsy: A Randomized Controlled Trial

Abstract

Background. The objective of this study was to evaluate the efficacy of adding single doses of ceftriaxone and amikacin to a ciprofloxacin plus metronidazole regimen on the reduction of infectious complications following transrectal ultrasound-guided prostate biopsy (TRUS Bx). Materials and Methods. Four hundred and fifty patients who were candidates for TRUS Bx were divided into two groups of 225 each. The control group received ciprofloxacin 500 mg orally every 12 hours together with metronidazole 500 mg orally every 8 hours from the day prior to the procedure until the fifth postoperative day. In the second group, single doses of ceftriaxone 1 g by intravenous infusion and amikacin 5 mg/kg intramuscularly were administered 30–60 minutes before TRUS Bx in addition to the oral antimicrobials described for group 1. The incidence of infection was compared between the groups. Results. The incidence of infectious complications in the intervention group was significantly lower than that in the control group (4.6% versus 0.9%, p = 0.017). Conclusion. The addition of single doses of intramuscular amikacin and intravenously infused ceftriaxone to our prophylactic regimen of ciprofloxacin plus metronidazole resulted in a statistically significant reduction of infectious complications following TRUS Bx.

Occurrence and significance of fluoroquinolone-resistant and ESBL-producing Escherichia coli and Klebsiella pneumoniae complex of the rectal flora in Ghanaian patients undergoing prostate biopsy

“…Several studies using prophylactic antibiotics to reduce post-biopsy infectious complications have reported success, mostly with amikacin and meropenem. 41 , 48 , 50–53 However, several studies also do not recommend their routine use for prophylaxis because of the selection and spread of antibiotic resistance. 42 , 52 , 54 , 55 Given that 3.1% of TRUS-B patients developed post-biopsy complications, the option for no antibiotic prophylaxis pre-TRUS-B has also been proposed for our setting in the attempt to reduce the selective burden of FQ-resistant and ESBL-positive pathogens.…”

Update on Strategies to Reduce Infectious Complications After Prostate Biopsy

“…The augmented prophylaxis can lead to questionable dimensions in terms of antimicrobial stewardship: In the most recent study performed in Iran, the authors randomised 450 patients to a combination of four different antimicrobials (ceftriaxone plus amikacin plus ciprofloxacin plus metronidazole) or the standard prophylaxis (ciprofloxacin plus metronidazole) [13]. The incidence of infectious complications in the intervention group was reported to be significantly lower than that in the control group (4.6% vs 0.9%, p = 0.017).…”