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Updated: Aug 11, 2026
Povidone Iodine Rectal Preparation at Time of Prostate Needle Biopsy is a Simple and Reproducible Means to Reduce Risk of Procedural Infection
Published on: September 21, 2015
A randomized comparative study of the prophylactic use of trimethoprim-sulfamethoxazole versus
I W Fong1, N Struthers, R J Honey
1Department of Medicine, St. Michael's Hospital, University of Toronto, Ontario, Canada.
Abstract:
An open randomized study was done to compare the prophylactic value of single doses of netilmycin-metronidazole versus trimethoprim-sulfamethoxazole in the prevention of postoperative infections associated with transrectal prostatic biopsy. Of 117 patients enrolled in the study 101 were evaluated and of these patients 47 received netilmycin-metronidazole and 54 received trimethoprim-sulfamethoxazole. The bacteremia rate in the netilmycin-metronidazole group was 28% (13 of 47 patients) with a 95% confidence interval of 18 to 42% and in the trimethoprim-sulfamethoxazole group it was 37% (20 of 54) with a confidence interval of 26 to 50% (p = 0.43). None of the patients with bacteremia was symptomatic. Urinary tract infection rates were greater in the netilmycin-metronidazole group: 17% (8 of 47 patients) versus 2% (1 of 54) in the trimethoprim-sulfamethoxazole group, p = 0.01. Trimethoprim-sulfamethoxazole (cotrimoxazole) is a better choice as an antimicrobial prophylaxis for patients undergoing transrectal prostatic biopsy.
Insights
Trimethoprim-sulfamethoxazole is a better choice for preventing infections after transrectal prostatic biopsies compared to netilmycin-metronidazole. This study found lower urinary tract infection rates with trimethoprim-sulfamethoxazole.
Area of Science:
- Urology
- Infectious Diseases
- Pharmacology
Background:
- Postoperative infections are a concern following transrectal prostatic biopsy.
- Antimicrobial prophylaxis is commonly used to prevent these infections.
- Comparing different antibiotic regimens is crucial for optimizing patient outcomes.
Purpose of the Study:
- To compare the prophylactic efficacy of single-dose netilmycin-metronidazole versus trimethoprim-sulfamethoxazole.
- To evaluate the rates of bacteremia and symptomatic urinary tract infections (UTIs) after transrectal prostatic biopsy.
Main Methods:
- An open-label, randomized study.
- 101 patients undergoing transrectal prostatic biopsy were evaluated.
- Patients received either netilmycin-metronidazole or trimethoprim-sulfamethoxazole.
Main Results:
- Bacteremia rates were 28% for netilmycin-metronidazole and 37% for trimethoprim-sulfamethoxazole (p=0.43).
- Symptomatic bacteremia was not observed in any patient.
- Urinary tract infection rates were significantly higher in the netilmycin-metronidazole group (17%) compared to the trimethoprim-sulfamethoxazole group (2%) (p=0.01).
Conclusions:
- Trimethoprim-sulfamethoxazole (cotrimoxazole) demonstrated superior performance in preventing UTIs post-biopsy.
- Trimethoprim-sulfamethoxazole is recommended as the preferred antimicrobial prophylaxis for transrectal prostatic biopsy.
