Between a Short‑term and a Long‑term Antimicrobial Prophylaxis in Prostate Biopsy: The Applicability in a Low‑resource Setting

Abstract

Background: Transrectal needle biopsy of the prostate (TNBP) is a common urological procedure with some attendant infective  complications. Although most urological surgeons give antibiotic prophylaxis, there is, however, no consensus on the duration. This study compares the outcome of a three‑day and seven‑day antibiotic prophylaxis in TNBP.

Materials and Methods: One hundred and twenty men who met the inclusion criteria were recruited and randomized into two equal groups. The patients in Group I received oral ciprofloxacin and metronidazole for three days and Group II received the same drugs for seven days. The antibiotics were commenced 2 h before the biopsy. Urine samples were taken for microscopy, culture, and sensitivity before the biopsy in all patients. For patients in group I, urine microscopy, culture and sensitivity were done on days 5 and 10 after biopsy, and on days 10 and 14 after biopsy for group II patients.  Infective complications were determined by the presence of fever and positive urine cultures post-biopsy.

Results: This comparative  prospective study was done between June 2016 and November 2017. Groups I and II had comparable infective complication rates (11.70% for Group I and 3.30% for Group II) (P = 0.212). However, diabetics did better on a seven‑day regimen (P < 0.001). Escherichia coli was the most common organism isolated (63.2%). Cephalosporins were the most effective antibiotics in post-biopsy infections in this study.

Conclusion: Three‑day oral ciprofloxacin and metronidazole are effective for prophylaxis in TNBP. However, a seven‑day regimen is better in diabetics before a prostate biopsy. The cephalosporins are a good option in the management of post-biopsy infections caused by quinolone‑resistant organisms.