Antimicrobial prophylaxis for transrectal prostatic biopsy: a prospective study of ciprofloxacin vs piperacillin/tazobactam.

Abstract

OBJECTIVE:

To compare the efficacy of short-term parenteral prophylaxis with piperacillin/tazobactam (P/T) with long-term oral prophylaxis with ciprofloxacin in preventing infective complications after transrectal prostatic biopsy (TPB).

PATIENTS AND METHODS:

Patients scheduled for TPB were randomized to receive P/T (2250 mg intramuscular) twice daily for 2 days (Group 1), or ciprofloxacin (500 mg orally) twice daily for 7 days (Group 2), beginning on the evening before the procedure in both groups. All patients received a 100-mL phosphate enema 3 h before TPB. Evaluation included self-recording of body temperature in the 3 days after TPB, and culture of mid-stream urine (MSU) samples taken before and 3 and 15 days after TPB. Patients with indwelling urethral catheters or taking antibiotics or immunosuppressive drugs were excluded, as were patients with positive MSU cultures before TPB.

RESULTS:

Of the 138 evaluable patients, 72 received parenteral P/T and 66 oral ciprofloxacin. Bacteriuria (> 105 c.f.u./mL) after TPB occurred in two of 72 (2.8%) patients in Group 1 and in three of 66 (4.5%) patients in Group 2; this difference was not statistically significant (P > 0.1). However, of the five patients with bacteriuria, two were symptomatic and both were in Group 2. Pyrexia occurred in only one patient in Group 2 with symptomatic urinary tract infection, and required hospitalization. No other patient reported a body temperature openface> 37.5 degrees C or drug-related side-effects.

CONCLUSIONS:

This prospective study showed that short-term prophylaxis with P/T was associated with a low rate of asymptomatic bacteriuria, requiring no further treatment, whereas although the rate was similar on long-term prophylaxis with ciprofloxacin patients required further treatment, with one needing hospitalization. We recommend short-term prophylaxis with P/T despite its disadvantages of cost and parenteral administration.

• Authors: L Cormio, B Berardi, A Callea, N Fiorentino, D Sblendorio, V Zizzi, A Traficante
• Journal: BJU international (BJU Int) Vol. 90 Issue 7 Pg. 700-2 (Nov 2002) ISSN: 1464-4096 [Print] England
• PMID: 12410751 (Publication Type: Clinical Trial, Comparative Study, Journal Article, Randomized Controlled Trial)

Chemical References

• Anti-Infective Agents
• Enzyme Inhibitors
• Penicillins
• Ciprofloxacin
• Penicillanic Acid
• Tazobactam
• Piperacillin

Topics

• Anti-Infective Agents (administration & dosage)
• Antibiotic Prophylaxis (methods)
• Bacterial Infections (prevention & control)
• Biopsy (adverse effects, methods)
• Ciprofloxacin (administration & dosage)
• Drug Therapy, Combination (administration & dosage)
• Enzyme Inhibitors (administration & dosage)
• Humans
• Injections, Intramuscular
• Male
• Penicillanic Acid (administration & dosage, analogs & derivatives)
• Penicillins (administration & dosage)
• Piperacillin (administration & dosage)
• Postoperative Complications (prevention & control)
• Prospective Studies
• Prostatic Diseases (pathology)
• Tazobactam
• Transurethral Resection of Prostate (methods)