Related Experiment Videos
Antimicrobial prophylaxis for transrectal prostatic biopsy: a prospective study of ciprofloxacin vs
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.
Insights
Short-term piperacillin/tazobactam (P/T) prophylaxis effectively prevents infective complications after transrectal prostatic biopsy (TPB). While similar rates of asymptomatic bacteriuria were observed, P/T required less follow-up treatment compared to ciprofloxacin.
Area of Science:
- Urology
- Infectious Diseases
- Pharmacology
Background:
- Transrectal prostatic biopsy (TPB) carries a risk of infectious complications.
- Antibiotic prophylaxis is standard practice to mitigate these risks.
- Comparing different prophylactic regimens is crucial for optimizing patient outcomes.
Purpose of the Study:
- To compare the efficacy of short-term parenteral piperacillin/tazobactam (P/T) with long-term oral ciprofloxacin in preventing infective complications post-TPB.
- To evaluate the incidence of bacteriuria and symptomatic urinary tract infections (UTIs) after TPB under different prophylactic strategies.
Main Methods:
- A prospective randomized study involving 138 patients scheduled for TPB.
- Group 1 received 2-day intramuscular P/T; Group 2 received 7-day oral ciprofloxacin.
- Infection surveillance included temperature monitoring and mid-stream urine cultures.
Main Results:
- No statistically significant difference in bacteriuria rates between P/T (2.8%) and ciprofloxacin (4.5%) groups.
- Two patients with bacteriuria were symptomatic, both in the ciprofloxacin group.
- One patient in the ciprofloxacin group developed a symptomatic UTI requiring hospitalization; no other significant complications were reported.
Conclusions:
- Short-term P/T prophylaxis is associated with a low rate of asymptomatic bacteriuria post-TPB.
- While bacteriuria rates were similar, ciprofloxacin prophylaxis led to symptomatic infections requiring treatment.
- Parenteral P/T is recommended for short-term prophylaxis due to its efficacy, despite cost and administration challenges.