Antibiotic prophylaxis prior to urologic surgical conditions

In August 2011, the  American Urological Association (AUA) updated its document “Best Practice Policy Statement on Urologic Surgery Antibiotic Prophylaxis,” including information about antibiotic propylaxis prior to a transrectal biopsy.

Transrectal biopsy is probably the most common surgical procedure carried out by urologic surgeons and is an inevitable element of the work-up of men at risk for prostate cancer.

There have been recent concerns about an apparent increase in risk for infections among men undergoing prostate biopsies, so it would be useful for men to be aware of the most current AUA recommendations.

The full text of the AUA’s recommendation for antibiotic prophylaxis is available on page 18 of the complete best practice document. However, the basic recommendation can be summarized as follows:

  • Antibiotic prophylaxis is recommended for all patients undergoing transrectal prostate biopsy.
  • There is Level 1 evidence that
    • Men who receive oral ciprofloxacin have a lower level of bacteriuria that men treated with a placebo in a randomized clinical trial.
    • In a three-arm clinical trial ciprofloxacin + tinidazole given as a single dose or twice a day for 3 days, the incidence of urinary tract infections and of all infectious complications was significantly lower in the men receiving either form of antibiotic therapy than it was in men treated with a placebo and the single dose regimen was just as effective as the 3-day regimen.
    • Other randomized clinical trials have confirmed that single-dose or one-day antibiotic regimens are just as effective as 3-day regimens in the prevention of infections among men undergoing transrectal biopsy.

From the patients’ point of view, the critical issue is ensuring that one is given a prescription for — and actually takes — an appropriate antibiotic regimen immediately preceding a prostate biopsy.

2 Responses

  1. La salud de todos los grupos poblacionales es importante para el desarrollo de los pueblos. En caso de la Salud del hombre merecer nuestra atención tomando en cuenta que el sexo masculino no practica de cierto modo la prevención, en este caso prevención sobre cáncer de Próstata oportunamente. .

  2. There is always the exception. Got a severe infection and was hospitilized at Washington University-Barnes Hospital for 4 days after receiving the single dose of ciprofloxacin prior to biopsy. Then it took 1.5 years for PSA to return to pre-biopsy level. No prostate cancer found on biopsy, but acute and chronic inflammation.

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