A recent prospective randomized study evaluated short-term antibiotic prophylaxis regimens for preventing infectious complications after transrectal ultrasound-guided prostate biopsies. Analyzing 544 patients between January 2021 and December 2022, researchers found low overall complication rates across regimens involving fosfomycin trometamol and ciprofloxacin.
Clinical Trial Design and Patient Cohorts
Prostate cancer is the most common malignant solid tumour in men aged >70 years and is the second most common cause of death from oncological circumstances. To mitigate post-biopsy infectious complications, a prospective randomized study assessed 605 transrectal ultrasound-guided prostate biopsies performed between January 2021 and December 2022. Out of this total, 544 patients met the inclusion criteria for the analysis.
Patients were randomized into three distinct prophylactic groups based on their medication schedule. Group 1 received a combination of fosfomycin trometamol (3 g, 3 h before the procedure) and ciprofloxacin (500 mg, 2 h before the procedure). Group 2 received fosfomycin trometamol (3 g, 3 h before and 24 h after the procedure). Group 3 received ciprofloxacin (500 mg 12, 2 h before the procedure, and 12 h after the procedure).
Evaluating Efficacy and Infectious Complications
Prior to undergoing the biopsy, a rectal swab was performed 1–2 weeks beforehand to evaluate the culture findings. Post-procedure complications were evaluated during follow-up visits within one month after the intervention. The findings demonstrated a low overall incidence of infectious complications, occurring in 10 cases (1.83%) across the entire cohort.
When broken down by regimen, infectious complications occurred in 3 patients in Group 1, 4 patients in Group 2, and 3 patients in Group 3. There was no statistically significant difference between the individual groups. Furthermore, none of the patients required hospitalization and all were free of symptoms of sepsis during the monitoring period.
| Prophylaxis Group | Regimen Details | Patient Count (N) | Infectious Complications |
|---|---|---|---|
| Group 1 | Fosfomycin trometamol (3h pre) + Ciprofloxacin (2h pre) | 184 | 3 |
| Group 2 | Fosfomycin trometamol (3h pre & 24h post) | 161 | 4 |
| Group 3 | Ciprofloxacin (12h, 2h pre, & 12h post) | 199 | 3 |
In Plain English: The Clinical Takeaway
- Flexible Prophylaxis: Short-term antibiotic prophylaxis in PB using fosfomycin trometamol, ciprofloxacin, or their combination appears to be effective.
- Fosfomycin as an Alternative: Fosfomycin trometamol is a suitable alternative to fluoroquinolone antibiotics.
- Low Risk Profile: Infectious complications occurred in 1.83% of patients, with zero reported cases requiring hospitalization or developing into sepsis.
Pharmacological Mechanisms and Global Health Implications
Short-term antibiotic prophylaxis in PB using fosfomycin trometamol, ciprofloxacin, or their combination appears to be effective. Fosfomycin trometamol is a suitable alternative to fluoroquinolone antibiotics.
Contraindications & When to Consult a Doctor
References
Disclaimer: This article is for informational purposes only and does not substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions regarding a medical condition.
