Prospective assessment of the efficacy of single dose versus traditional 3‐day antimicrobial prophylaxis in 12‐core transrectal prostate biopsy

Abstract

Objectives: To prospectively evaluate the efficacy of single dose antibiotic prophylaxis in 12-core transrectal ultrasonography (TRUS) guided prostate biopsy. Methods: A total of 400 patients who underwent prostate biopsy with TRUS guidance were included. The patients were prospectively randomized in three groups regarding antibiotic prophylaxis. The first group (139 patients) received a single gram of intramuscular ceftriaxone, while the second group (131 patients) had a 3-day course of oral ciprofloxacin. The third group (130 patients) had single oral 500 mg of ciprofloxacin. All patients had urine cultures prior to biopsy and on the second day after biopsy. Results: The study groups were compared in terms of the results of urine cultures and clinical parameters. Overall, only seven patients (1.8% of the cases) had positive urine cultures with no difference between these three groups. Additionally, no significant difference was observed regarding morbidity rates in all groups. Only eight patients (2%) developed major complications requiring hospitalization. There was no increase in the rate of infectious complications when the biopsy core numbers were increased up to 12. Conclusions: The current study suggests that a single oral dose of antimicrobial prophylaxis is reasonable in TRUS prostate biopsy even in the case of 12-core sampling.

Profilaxis antibiótica en la biopsia transrectal de próstata

“…Al analizar la eficacia de la monodosis frente a la pauta corta, en tres de los trabajos revisados no se observaron diferencias estadísticamente significativas entre ambas pautas 9,25,30 . Sólo en un trabajo se objetivó que la pauta corta era clínica y analíticamente superior a la monodosis 31 .…”

“…Cam et al 25 , en un estudio prospectivo, aleatorizado, de 400 pacientes distribuidos aleatoriamente en tres grupos, que recibieron ceftriaxona intramuscular (grupo 1), ciprofloxacino por vía oral durante 3 días (grupo 2) o ciprofloxacino por vía oral en monodosis (grupo 3), no encontraron diferencias significativas entre los tres grupos.…”

“…Diferentes autores han comparado las complicaciones infecciosas de las quinolonas administradas en monodosis frente a las pautas cortas y no han observado diferencias entre ambos grupos 9,25,30 . Sólo un trabajo de los revisados recoge diferencias significativas a favor de la pauta corta, que presentó una menor tasa de fiebre y urocultivos comparada con la monodosis 32 .…”

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

“…[25] E. coli is the most frequently isolated bacteria from positive urine cultures. [21,23] In our study, in all cases with urine culture positivity E. coli was isolated. Though fluoroquinolones were effective in the prophylaxis of prostate biopsy, increased resistance to fluoroquinolone therapy has been also detected.…”

“…[22] In a study where infective complications were evaluated, the authors had achieved comparable outcomes with single dose 500 mg ciprofloxacin prophylaxis, twice daily doses of 500 mg ciprofloxacin, and a single dose parenteral ceftriaxone prophylaxis. [23] Presence of urinary infection before biopsy carries a risk for infective complications. Therefore, prebiopsy urinalysis can reveal risk of infection.…”