Guidelines Recommend Quinolones for Preventing Infections following Prostatic Biopsy 

1 September, 2017

The incidence of infections, including fatal ones, following prostatic biopsy is growing, especially as resistant causative bacteria increases. These complications are associated with higher healthcare costs so prophylactic antibiotic therapy is advocated at the time of the biopsy. However consideration needs to be given to the route of biopsy (transrectal versus transperineal) before choosing the optimal preventive therapy. Intestinal bacteria are the most likely causative pathogens associated with the transrectal approach (E. coli, including resistant organisms, are the most common, followed by Klebsiella, Enterobacter and other species).

The Japanese guidelines for preventing perioperative prostatic infection have been recently revised, updating earlier guidelines and incorporating additional data from more than 1100 articles published between 2000-2016. The guidelines differentiate patients based on biopsy approach. They recommend that all transperineal biopsied patients and those treated with a transrectal approach who have not had antibiotics within 3-6 months and without risk factors (prostate volume ≤75ml, diabetes mellitus, steroids, severe dysuria, immunocompromised) should be treated with a single dose of levofloxacin (plus aminoglycoside if needed). However, for transrectal biopsies in patients who have received antimicrobial treatment within the previous 6 months, a rectal biopsy should be taken and results individualised. In these patients treatment can include levofloxacin, piperacillin tazobactam or alternative agents. The guidelines also stress the need to empirically administer broad-spectrum antimicrobials to all patients who develop a febrile infection after a prostate biopsy.

The Japanese guidelines differ slightly from Western ones, using an algorithm based on biopsy technique. However all guidelines recommend quinolones as they are known to have excellent prostatic penetration. The EAU advocates a single dose in low risk cases, with an extended duration to be used in high risk patients. The AUA recommends 24 hour quinolone therapy in all cases. The report noted that while trimethoprim/sulfamethoxazole has been recommended by the EAU, and cephalosporins and aminoglycosides by the AUA as alternative agents, these agents are not recommended by the JUA (Japanese Urological Association) because of insufficient evidence.

PMID: 28556409

Int J Urol. 2017 Jul;24(7):486-492. doi: 10.1111/iju.13369. Epub 2017 May 27.

Source: https://www.ncbi.nlm.nih.gov/pubmed/28556409?dopt=Abstract