Retrospective analysis of the effectiveness of pre-biopsy prophylactic antibiotic regimen to prevent acute prostatitis

Purpose: We aimed to investigate the incidence and characteristics of acute prostatitis after transrectal prostate biopsy in men whom were given prophylactic ceftibuten combined with gentamicin. Materials and Methods: We analyzed the retrospective data from 245 patients who underwent transrectal ultrasound (TRUS) guided prostate biopsy over a 2 year period. Men in which acute prostatitis occured after the procedure were investigated. All patients received 400 mg ceftibuten orally once daily for 5 days, beginning 12 and 2 hours before biopsy; combined with single dose 160 mg gentamicin intramuscularly just before the procedure. All biopsies were performed as outpatient procedures. Results: Of the 245 cases, acute prostatitis developed in 2 (0,8%). Escherichia Coli that was positive for extended spectrum β-lactamase activity was isolated both from blood and urine in 1 case. The bacteria detected in urine and blood cultures were resistant to ciprofloxacin, levofloxacin, gentamicin, cefepime, ceftriaxone and cufuroxime. However, no bacteria was isolated either from blood or urine in the other case. Both patients had acute prostatitis after the first biopsy. Conclusion: Prophylactic ceftibuten combined with single dose gentamicin seems effective in preventing acute bacterail prostatitis after TRUS-guided prostate biopsy. Due to increasing rate of quinolone resistance among the world, alternative prophylaxis regimens including cephalosporins such as ceftibuten should be considered in men undergoing prostate biopsy. Prospective randomized trials with larger series may give more conclusive data. Keywords Antibiotic prophylaxis, Acute prostatitis, Ceftibuten, Prostate biopsy