Oral ciprofloxacin or trimethoprim reduces bacteriuria after flexible cystoscopy

Abstract

OBJECTIVE To report a large prospective, pragmatic, double‐blind randomized controlled trial to determine whether oral prophylactic antibiotics reduce the risk of bacteriuria after flexible cystoscopy (FC), as up to 10% of patients develop urinary infection afterwards, with significant morbidity and costs for health services. PATIENTS AND METHODS In all, 2481 patients were recruited into a three‐arm placebo controlled trial and 2083 completed it. Patients were randomly assigned to one of three treatments; (i) placebo; (ii) one oral dose of trimethoprim (200 mg); or (iii) one oral dose of ciprofloxacin (500 mg), each administered 1 h before a FC under local anaesthetic. A mid‐stream urine specimen was taken before and 5 days after FC; significant bacteriuria was defined as a pure growth of >105 colony‐forming units/mL. RESULTS The rate of bacteriuria after FC was reduced from 9% in the placebo group to 5% and 3% in patients receiving trimethoprim and ciprofloxacin prophylaxis, respectively. When rates of bacteriuria before FC were considered the odds of developing bacteriuria after FC relative to baseline were 5, 2 and 0.5 for placebo, trimethoprim and ciprofloxacin, respectively. CONCLUSION This large trial shows clearly that one dose of oral ciprofloxacin significantly reduces bacteriuria after FC.

A randomised single‐blind comparison of the effectiveness of Tristel Fuse (chlorine dioxide) as an office‐based fluid soak, with Cidex OPA (ortho‐phthaldehyde) using an automated endoscopic reprocessor (AER) as high‐level disinfection for flexible cystoscopes

“…The positive culture from the decontaminating tray is unlikely to be of any clinical significance and probably represented contamination. The number of UTIs was consistent with known data from other studies and showed no association with disinfection type [6]. The adverse events noted were expected and typical after flexible cystoscopy.…”

“…This endpoint was judged to be the least sensitive (and therefore requiring the largest sample size) of the patient-related outcomes in this setting. The calculation was based on data that suggested that the rate of UTIs after cystoscopy was between 2% and 10% [6]. We assumed a UTI rate after cystoscopy of 2.5% for Cidex OPA, therefore if the rate for Tristel Fuse is Յ5% then there would be an 80% chance that the upper limit on the 95% one-tailed CI of the difference would be <10%.…”

¿Está indicada la profilaxis antibiótica con ciprofloxacino en la realización de cistoscopia flexible?

“…La infección urinaria y la presencia de bacteriuria es poco frecuente tras la cistoscopia flexible 7 y existe una baja incidencia de bacteriuria 8 , a pesar de lo cual, diferentes autores analizan el papel de la profilaxis antibiótica en la realización de este procedimiento. Alguno de esos estudios defienden que el uso de ciprofloxacino como profilaxis reduce significativamente la bacteriuria frente a placebo y a trimetoprim 6 , mientras que otros no observan diferencias en el uso o no de profilaxis antibiótica 9,10 . El estudio de Johnson et al 6 demuestra que la administración de 1 hora antes de la cistoscopia flexible de 500 mg de ciprofloxacino reduce de forma significativa la bacteriuria frente a placebo y frente a trimetoprim.…”

“…Alguno de esos estudios defienden que el uso de ciprofloxacino como profilaxis reduce significativamente la bacteriuria frente a placebo y a trimetoprim 6 , mientras que otros no observan diferencias en el uso o no de profilaxis antibiótica 9,10 . El estudio de Johnson et al 6 demuestra que la administración de 1 hora antes de la cistoscopia flexible de 500 mg de ciprofloxacino reduce de forma significativa la bacteriuria frente a placebo y frente a trimetoprim. En nuestro estudio observamos que ciprofloxacino 500 mg administrado una hora antes del procedimiento ni reduce ni evita la aparición de síntomas de infección urinaria, bacteriuria o asistencia a Profilaxis antibiótica y cistoscopia flexible -M. del C. Cano-García et al figura 1.…”

“…En líneas generales, se considera que la cistoscopia no se asocia con una elevada percepción de dolor, siendo en cualquier caso habitualmente mayor en el primer procedimiento y disminuyendo en los posteriores, de tal manera que es tolerada tanto en hombres como en mujeres con anestesia local 4 . En la actualidad, aunque la Guía Europea de Urología 5 recomienda únicamente profilaxis antibiótica en pacientes de alto riesgo, los protocolos en cada hospital son diferentes y todavía sigue haciéndose profilaxis para disminuir el riesgo de bacteriuria e incluso existen estudios que afirman que el uso de antibióticos previene o disminuye la bacteriuria 6 . El objetivo de este estudio es comparar la existencia de bacteriuria y síntomas de infección urinaria en pacientes sometidos a cistoscopia flexible con ciprofloxacino, frente a no tomar profilaxis.…”