Prophylaxis Antibiotics for TRUS Biopsy: A Retrospective Analysis Comparing 2 Regimens

Abstract

Background: Transrectal ultrasound guided prostate biopsy (TRUSBx) is a common urological procedure and quinolones has been widely used as a prophylactic antibiotic. However, controversies arise as there is increased incidence of quinolones resistance and side effect associated with it. Thus, this study will retrospectively review and compare the infectious outcome of Fosfomycin and ciprofloxacin as prophylaxis antibiotic regimens prior to TRUSBx. Study Design:  Retrospective analysis Place and Duration of Study: Urology Unit, Surgical Department, Hospital Raja Perempuan Zainab II, Kelantan from February 2020 to April 2021. Methodology: Records of all patients who underwent TRUSBx in Hospital Raja Perempuan Zainab II, Kelantan from February 2020 to April 2021 reviewed. Patients were divided into 2 groups. In Group 1, patients received single-dose Fosfomycin (3 g, orally) the night before TRUSBx. In Group 2, patients received oral ciprofloxacin 500mg bd 1 day before TRUSBx and continued this twice daily to complete the total dose for 3 days. Short term outcomes in terms of infectious complications were compared. Results: Study includes 188 patients (Group 1: 70 patients received single-dose oral Fosfomycin 3 g and Group 2: 118 patients received oral ciprofloxacin 500mg bd for 3 days). There was no significant mean difference in age, PSA, and prostate size between groups (P>.05). Only 2 patients from Group 1 and 4 patients from Group 2 developed afebrile UTI and successfully treated with oral antibiotic. Post-biopsy complicated UTI was observed in 1 patient (1.4%) in group 1 and 2 patients in group 2 (1.7%). There was no association between factors (types of prophylactic antibiotic given) and infectious complication rate (P>.05). Conclusion: The incidence of post-TRUSBx infectious complications is comparable between these 2 groups of prophylactic antibiotics Therefore, Fosfomycin should be considered as an alternative antibiotic as it has the advantage of single dose and it might reduce the incidence of quinolones resistance organism.