The use of prophylactic antibiotics in ultrasound-guided transrectal prostate biopsy

The use of antibiotic prophylaxis for transrectal prostate biopsy significantly reduces the incidence of infective complications, but no recommendations exist as to the most appropriate antibiotic regimen. This study was designed to find out which antibiotics were used in different departments and the financial cost of each regimen. A postal survey of 144 hospitals in the UK and Ireland was undertaken. Respondents were asked the name(s), dose(s), route(s) of administration and timing of antibiotics given pre and post biopsy. The response rate was 73.6%. Thirteen different antibiotics were used in 48 different regimens. The most commonly used antibiotic was metronidazole (orally or rectally) in 55% of regimens followed by oral ciprofloxacin in 48% and intravenous gentamicin in 48%. Most regimens (89.7%) contained an oral antibiotic and 58.6% contained an intravenous antibiotic. The cheapest regimen cost 38.7p/patient and the most expensive pounds sterling 21.36/patient, calculated according to prices quoted in the British National Formulary, March 1996. We conclude that there is a lack of standardization in antibiotic prophylaxis for ultrasound-guided transrectal prostate biopsy with widely differing costs for the different regimens. A review of the literature shows that oral antibiotics are inexpensive, well tolerated and effective at reducing the incidence of urinary tract infection and fever following transrectal prostate biopsy. A regimen is proposed including ciprofloxacin or norfloxacin. The addition of oral metronidazole is a subject for further study.