Antibiotic prophylaxis in transurethral surgery: a comparison of sulbactam-ampicillin and cefoxitin

The efficacy and safety of perioperative prophylaxis with sulbactam-ampicillin or cefoxitin was compared in a prospective randomized double-blind study of 103 patients undergoing transurethral surgery. Fifty-two patients received 0.5 g sulbactam and 1 g ampicillin intramuscularly, 30 to 90 minutes prior to surgery, followed by the same dose administered intravenously every eight hours for a total of three additional doses over 24 hours. Fifty-one patients received 1 g of cefoxitin administered according to the same schedule as sulbactam-ampicillin. The incidence of urinary tract infection during hospitalization was 8% in the sulbactam-ampicillin group and 4% in the cefoxitin group. One month postoperatively the incidences were 3% and 5%, respectively. There was no significant difference between the groups in incidence of fever or length of postoperative hospital stay. Both drugs were well tolerated. No side effects were seen other than a mild skin rash in one patient and diarrhea in two patients. Sulbactam concentrated in prostatic tissue, and ampicillin together with sulbactam was found in concentrations above the minimal inhibitory concentration of most bacteria causing postoperative urinary tract infection. It is concluded that sulbactam-ampicillin and cefoxitin are equally effective and safe in preventing postoperative urinary tract infection in transurethral surgery.