Comparison between ciprofloxacin and trimethoprim-sulfamethoxazole in antibiotic prophylaxis for transrectal prostate biopsy

Abstract

Objective: The aim of this study was to compare the efficacies of oral ciprofloxacin administration and oral trimethoprim-sulfamethoxazole (TMP-SMX) regimens in preventing infectious complications following transrectal ultrasound guided biopsy of the prostate. Material and methods:Between 2011-2013, the medical records of 391 (mean age 64.62±7.64 years; range 40 to 87 years) patients who underwent transrectal prostate biopsies, due to suspicion of prostate cancer were retrospectively reviewed. While 500 mg ciprofloxacin was given orally twice daily starting one day before the procedure, continued for 3 days in the first 174 patients (group 1); was given orally twice daily starting one day before the procedure, continued for 3 days in the remaining 217 patients (group 2) for prophylaxis. Urine samples were obtained for urine culture before the procedure. The two groups were compared with respect to findings of urine cultures performed before and after the procedure and complications. Results:In the ciprofloxacin and groups, any positive urine culture before the procedure was not observed. Complications occured in 93 patients (37 in group 1 and 56 in group 2), after the procedure. Twenty-two (5.6%) (11 in group 1 and 11 in group 2). patients were admitted to our clinic because of high fever occurring after biopsy. Nine ciprofloxacin-treated (5.2%) and 16 TMP-SMX-treated (7.4%) patients had severe dysuria after the procedure. Twenty-one ciprofloxacin recipients (12.1%) and 40 TMP-SMX recipients (18.4%) had macroscopic hematuria. In the ciprofloxacin and TMP-SMX groups, the incidences of new culture positivity were 4% (n=7) and 2.8% (n=6) after the procedure, respectively. All of the isolated bacteria was Escherichia coli. While 11 patients were hospitalized due to signs of complicated urinary tract infections, and 2 patients were treated as outpatients. Rectal bleeding that did not require any intervention was observed in a patient 8 hours after biopsy. SIRS findings were detected in two patients. There were no significant differences between the two groups with respect to age, prostate volume, prostate spesific antigen (PSA) levels, and results of urine culture performed after the procedure (p>0.05). Conclusion:Despite the increasing resistance to antibiotics, ciprofloxacin and TMP-SMX are effective prophylactic treatment modalities for transrectal prostate biopsy. Both three-day ciprofloxacin and TMP-SMX regimens seem to be equally effective in the antibiotic prophylaxis for transrectal prostate biopsy.

Comparison of Ciprofloxacin with a Combination of Cefixime-Clavulanic Acid Treatment in the Prophylaxis of Transrectal Prostate Biopsy

“…In another study, a positive urine culture was observed in 4% of the patients in the ciprofloxacin group and in 2.8% of the patients in the TMP-SMX group. There was no significant difference in comparison of the two antibiotics (16) . Although antibiotic treatment was given before and after transrectal prostate biopsy, E. coli meningitis has been reported in the literature, so it is necessary to perform the TRUS-PB procedure within a certain discipline (17) .…”

Infective complications in patients after transrectal ultrasound-guided prostate biopsy and the role of ciprofloxacin resistant Escherichia coli colonization in rectal flora

“…[6,15] In multi-center studies where patients with urinary infection have been evaluated in many geographic regions of Turkey, rates of quinolone-resistance of E. coli strains isolated from urine cultures have been reported to range between 8.3, and 38 percent. [16,17] In a study by Atılgan et al [18] urine culture positivity was detected in 13 (3.3%) patients, and growth of E. coli was detected in all of these cultures. [18] Feliciano et al [6] reported infectious complication rate of 2.4% (1% in febrile cases) in patients in whom fluoroquinolone was used for prophylaxis.…”

“…[16,17] In a study by Atılgan et al [18] urine culture positivity was detected in 13 (3.3%) patients, and growth of E. coli was detected in all of these cultures. [18] Feliciano et al [6] reported infectious complication rate of 2.4% (1% in febrile cases) in patients in whom fluoroquinolone was used for prophylaxis. In the same study, in 17 of 19 patients with positive urine cultures, growth of E.coli was observed.…”

Current routines for antibiotic prophylaxis prior to transrectal prostate biopsy: a national survey to all urology clinics in Sweden

“…The use of fluoroquinolones as standard is supported by two meta-analyses showing that fluoroquinolones have significantly better effects compared with placebo in all included trials 3,7 . Other antibiotic agents that have been investigated alone or in addition to fluoroquinolones include trimethoprim-sulfamethoxazole, gentamicin, fosfomycin, piperacillin-tazobactam, amikacin, ceftriaxone, amoxicillin-clavulanate and meropenem 3,6,7,[21][22][23][24] . Most regiments appear to reduce the risk of infection but there is a lack of sufficiently powered randomized trials comparing fluoroquinolones to other antibiotic classes 7 .…”