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Dual-agent protocol may cut post-prostate biopsy infection rate

Regimen appears efficacious against fluoroquinolone-resistant E. coli

Washington—Results of a retrospective study documenting a significant risk of fluoroquinolone-resistant Escherichia coli infections after transrectal ultrasound-guided prostate biopsy (TRUSP) prompted a change in the antibiotic prophylaxis protocol for men undergoing this diagnostic procedure at one large institution.

The new regimen, which was developed based on consultation with infectious disease specialists, includes a single oral dose of ciprofloxacin (Cipro, Proquin XR) plus a single intramuscular dose of an aminoglycoside (originally gentamicin, but tobramycin is being used as an alternative as necessary due to a gentamicin shortage). Based on several months of experience, the dual-agent protocol appears effective for reducing the rate of post-TRUSP infections. However, a few cases of fluoroquinolone-resistant E. coli infections have occurred, said senior author J. Stephen Jones, MD, MBA, chairman and professor of regional urology at Cleveland Clinic's Glickman Urological & Kidney Institute.

"Unfortunately, those of us who have been warning about the need for judicious use of antibiotics to limit emerging bacterial resistance are now being validated by findings of high rates of infection due to antibiotic-resistant organisms," Dr. Jones told Urology Times. "As the problem seems to worsen before our eyes, we are continuing to advocate appropriate antibiotic prescribing but are also being forced into considering use of additional agents for prophylaxis based on problems with ongoing resistance.

"Our new dual regimen is not too expensive, and we are encouraged by the fact that it seems to have reduced the rate of fluoroquinolone-resistant E. coli infections to a very low level. However, the rate is still not zero. Therefore, we and others in the U.S. and elsewhere around the world are continuing to work to identify a solution that is cost-effective and safe for patients."

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Most of the urologists interviewed for this article say post-biopsy infection is something they are watching and that they are considering changes to their regimens to counter the problems that have been reported.

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Decontamination of the rectum with povidone-iodine prior to transrectal ultrasound (TRUS)-guided prostate biopsy does not yet appear to be efficacious in reducing infection rates.