Antibiotic prophylaxis and complications following prostate biopsies - a systematic review
Nina Klemann1, John Thomas Helgstrand, Klaus Brasso
1ninakhp@gmail.com.
Introduction:
Transrectal ultrasound-guided biopsies (TRUS-gb) are associated with both mild and serious complications. Prophylactic antibiotics reduce the risk of septicaemia and mortality; however, no international consensus exists on the timing and duration of antibiotics, including the optimal drug strategy. We reviewed the current evidence supporting use of prophylactic antibiotics and the risk of complications following prostate biopsies.
Methods:
This review was drafted in accordance with the Prisma Guidelines. The PubMed, Embase and Cochrane databases were searched.
Results:
A total of 19 eligible trials were identified. One trial demonstrated a significant reduction in the risk of infection after biopsy and reported that oral ciprofloxacin as either a single-dose or a three-day regimen was superior to oral chloramphenicol and norfloxacin. Of three studies investigating the timing of the first dose of antibiotic, one study found that administration 24 h before biopsy versus administration immediately before reduced the relative risk of post-biopsy infection by 55%. Seven studies compared different durations of antibiotic prophylaxis. None showed any benefit from continuing prophylaxis beyond a single dose or a one-day regimen.
Conclusion:
Evidence supporting a specific antibiotic regimen for TRUS-gb prophylaxis is scarce. Widespread use of fluoroquinolone prophylaxis may be associated with an increase in resistant Escherichia coli strains, posing a potentially major health issue in the future. .
Insights
Prophylactic antibiotics for transrectal ultrasound-guided biopsies (TRUS-gb) show limited evidence for specific regimens. Single-dose oral ciprofloxacin may reduce infection risk, but widespread use raises concerns about antibiotic resistance.
Area of Science:
- Urology
- Infectious Disease
- Pharmacology
Background:
- Transrectal ultrasound-guided biopsies (TRUS-gb) carry risks of complications, including infection.
- Prophylactic antibiotics can mitigate risks like septicaemia and mortality.
- Current international guidelines lack consensus on optimal antibiotic timing, duration, and drug choice for TRUS-gb.
Purpose of the Study:
- To review existing evidence on prophylactic antibiotic use for TRUS-gb.
- To assess the risk of complications associated with prostate biopsies.
- To evaluate optimal antibiotic strategies for TRUS-gb.
Main Methods:
- Systematic review adhering to Prisma Guidelines.
- Searched PubMed, Embase, and Cochrane databases for eligible trials.
- Included 19 randomized controlled trials.
Main Results:
- Oral ciprofloxacin (single-dose or 3-day) showed superiority over chloramphenicol and norfloxacin in reducing infection risk.
- Administering the first antibiotic dose 24 hours pre-biopsy reduced infection risk by 55% compared to immediate pre-biopsy administration.
- No significant benefit was observed for antibiotic prophylaxis durations longer than a single dose or one day.
Conclusions:
- Limited evidence supports specific antibiotic regimens for TRUS-gb prophylaxis.
- Potential for increased fluoroquinolone resistance in *Escherichia coli* strains due to widespread use.
- Further research is needed to establish optimal antibiotic strategies and address resistance concerns.
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