Short-term cephalosporin prophylaxis in transurethral surgery

The effects of three short-term prophylactic cephalosporin regimens were compared in a prospective, randomized, double-blind study. One hundred sixteen men, with sterile urine preoperatively, underwent transurethral surgery (resection of the prostate or bladder neck, 73; resection or fulguration of bladder tumors, 38; or internal urethrotomy, 5). One group received 1 gm of cefotaxime parenterally 30 to 90 minutes preoperatively, every 60 to 90 minutes during surgery, and immediately postoperatively. In the other two groups, 1 gm of cefotaxime or cefazolin was administered according to the regimen used in the first group and also every eight hours for 24 hours postoperatively. All three prophylactic regimens significantly lowered the incidence of infection three and five to seven days postoperatively, the incidence being approximately 5% as compared with an incidence of about 40% found in an earlier study in which a placebo was used. The results with the three regimens were not significantly different. Our data showed that to prevent postoperative urinary tract infection, prophylactic antibiotics need only be administered immediately perioperatively in uninfected patients who undergo transurethral surgery; longer prophylaxis is unnecessary.