Introduction

Prophylactic antibiotics are recommended prior to prostate biopsy. The main effect of antibiotic prophylaxis is a lowered incidence of postbiopsy bacteriuria. Although not all patients with bacteriuria are symptomatic, all patients who develop infectious complications following rectal biopsy are bacteriuric. Prostate biopsy performed without antibiotic prophylaxis is associated with increased rates of bacteriuria (8 to 44 percent) and bacteremia (16 to 70 percent) Major infectious complications, such as sepsis, Fournier gangrene, and urinary tract infection requiring hospital admission have been reported in patients who did not receive prophylactic antibiotics. Fluoroquinolones are the most widely used antibiotic for prophylaxis due to their broad spectrum of activity, easy oral administration, good penetration to prostate gland tissue, and long-lasting bactericidal activity. The development of resistant organisms is becoming an increasing problem and may lead to a need to alter the antibiotic régimen. The increase in the incidence of antibiotic-resistant infections following prostate biopsy is felt to be responsible for an increasing need for hospitalization after prostate biopsy ._x000D_ We developed a standard prophylactic regimen, in which security and efficacy are the priority; however the variability in costs is reduced._x000D_ Aim: _x000D_ To prospectively evaluate the efficacy of amikacin compared with levofloxacin as prophylactic measure in transrectal prostate biopsy._x000D_

Methods

A prospective, observational, comparative study, which included 393 patients who had standard indication of transrectal prostate biopsy. The study was conducted with a random choice and split into two groups, demographic characteristics were similar in both groups. Group A: 205 patients who were administered a single dose of levofloxacin (500 mg) orally 60-120 minutes before the procedure; and Group B: 188 patients who were given amikacin 15 mg / kg intramuscularly 60-120 min before the procedure. All patients underwent urinalysis and urine culture before and after the procedure. We identified post biopsy complications: bacteriuria, urinary tract infection, orchitis, pyelonephritis, sepsis, all of them were evaluated, all patients with a severe condition were hospitalized. The variables were correlated using Fishers Exact Test.

Results

In Group A, 4.3% of patients presented a febrile UTI and 0.97% presented sepsis. In Group B, 5.3% presented febrile UTI and .53% presented sepsis. Comparing both groups, we found no relationship between the dose and the risk for complications (p=0.52). In the group analysis considering DM, a significant relationship for complication risks was not found, Group A (p=0.62) and Group B (p=0.58). The same in the analysis of overweight and obesity no significant relationship with complications was found, Group A (p=0.85) and Group B (p=0.65).

Conclusions

Given its efficacy and simplicity, a single dose of 500mg of levofloxacin represents an excellent prophylaxis method in transrectal prostate biopsies guided by ultrasound. However, a single dose of amikacin shows similar results as levofloxacin, thus it can significantly reduce the cost of antibacterial therapy and have a similar safety profile.

Funding

None