• Vol. 38 No. 3, 212–216
  • 15 March 2009

Intramuscular Gentamicin Improves the Efficacy of Ciprofloxacin as an Antibiotic Prophylaxis for Transrectal Prostate Biopsy

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ABSTRACT

Introduction: Infection-related complications after transrectal ultrasound guided prostatic biopsy (TRPB) could be life threatening. Our centre observed sepsis after TRPB despite prophylactic oral ciprofloxacin. We reviewed all cases of post-TRPB sepsis with their bacteriology and evaluated if the addition of intramuscular (I/M) gentamicin to standard prophylaxis before TRPB could reduce its incidence. Materials and Methods: In a single urological centre, we performed an interventional study that compared a prospective group with retrospective control. The latter is known as the “cipro-only” group included consecutive patients who underwent TRPB between 1 September 2003 and 31 August 2004. The addition of I/M gentamicin 80mg half an hour before TRPB started on 1 September 2004. All subsequent patients who underwent TRPB until 31 August 2005 were included in the “cipro+genta” group. Patients who did not receive the studied antibiotics were excluded. Results: There were 374 patients in the “cipro+genta” group and 367 patients in the “cipro-only” group with comparable profiles. There were 12 cases of post-TRPB sepsis in the “cipro-only” group and 5 cases in the “cipro+genta” group. Ciprofloxacin-resistant Escherichia coli (E. coli) was the only pathogen isolated in both groups. In the “cipro-only” group, 9 patients had positive blood cultures and 8 were sensitive to gentamicin. In the “cipro+genta” group, the only positive E. coli was gentamicin-resistant. One patient in the “cipro+genta” group was admitted to the intensive care unit with septicaemia. Conclusion: The addition of I/M gentamicin to oral ciprofloxacin is a safe and effective prophylactic antibiotic regime in reducing the incidence of post-TRPB sepsis.


Transrectal ultrasound guided prostate biopsy (TRPB) is one of the modalities in the diagnosis of prostate cancer. Its use has increased with the widespread use of serum prostate-specific antigen (PSA). It is generally a safe procedure with acceptable complication rates.1 However, when infective complications occur, it is potentially fatal.2 The risk of such infection is reduced with prophylactic antibiotics.3 There is wide variation in the prophylactic antibiotic regimens used by the urologist with no consensus on the most appropriate type of antibiotic or its duration.4-6 Fluoroquinolones such as ciprofloxacin is one of the most commonly used prophylactic antibiotics for TRPB7 and our centre has been doing so for the past 10 years. Despite antibiotics prophylaxis, we observed cases of post-TRPB sepsis. In this study, we reviewed these cases and their bacteriology. Based on the findings, we introduced intramuscular (I/M) gentamicin to our standard prophylaxis of oral ciprofloxacin alone. We also compared the incidence of sepsis before and after its introduction.

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