[Single dose versus 5-day course of oral prulifloxacin in antimicrobial prophylaxis for transrectal prostate biopsy]

Abstract

Aim: Prostate biopsy and histology are necessary studies for diagnosing prostate cancer. The rationale for antimicrobial prophylaxis in urologic, diagnostic and treatment procedures is given by the possible risk of bacterial contamination. Since oral administration is generally preferred and the most common pathogens are Gram-negative bacteria, the antimicrobials of choice are fluoroquinolones and amoxicillin/clavulanic acid.

Methods: The study sample was 432 consecutively enrolled males (age range 44-82 years) who underwent transrectal ultrasound-guided prostate biopsy. The subjects were randomly assigned to 2 groups. One (210, 48.6%) received a single oral dose of prulifloxacin (600 mg) before the operation (group 1); the other (222, 51.4%) received a 5-day course of the antimicrobial.

Results: The most frequent events were bleeding (hematuria and hemospermia) (about 15%), which resolved spontaneously within several days. Fever, the chief symptom of infection, occurred in 4/432 (0.93%) and was equally distributed between the 2 groups (0.95% and 0.90% in groups 1 and 2, respectively). Patient compliance with antimicrobial prophylaxis was good to excellent. Histology of the prostate sample revealed carcinoma in 46.5%, and other prostate conditions in 53.5%: benign prostate hypertrophy, chronic prostatitis, high grade prostate intraepithelial neoplasia, and suspicious but not diagnostic atypia.

Conclusions: In patients undergoing transrectal ultrasound-guided prostate biopsy, antimicrobial prophylaxis with prulifloxacin, both in single shot and 5-day administration, was found to prevent infection, with good tolerability and acceptability by the patients.