Letter to the Editor
For Single Dosing, Levofloxacin is Superior to Ciprofloxacin when Combined with an Aminoglycoside in Preventing Severe Infections after Prostate Biopsy
Sen V*, Yonguc T, Bozkurt IH and Aydogdu O
Department of Urology, Izmir Bozyaka Training and Research Hospital, Turkey
*Corresponding author: Sen V, Department of Urology, Izmir Bozyaka Training and Research Hospital, Turkey
Published: 22 Nov, 2017
Cite this article as: Sen V, Yonguc T, Bozkurt IH, Aydogdu
O. For Single Dosing, Levofloxacin
is Superior to Ciprofloxacin when
Combined with an Aminoglycoside
in Preventing Severe Infections after
Prostate Biopsy. Clin Surg. 2017; 2:
1753.
Letter to the Editor
We have read the article by Unnikrishnan et al. [1] reporting the comparison of levofloxacin
and ciprofloxacin for preventing severe infections after prostate biopsy. Authors had changed the
ciprofloxacin 500 mg single dose plus aminoglycoside intramuscular single dose prophylaxis to
levofloxacin 750 mg single dose plus aminoglycoside intramuscular single dose because of increasing
infectious complications after TRUSBP in the present study. They detected a significant reduction
in severe infections after the switch to levofloxacin (2.43% vs. 0.92; P=0.04) and mentioned that
levofloxacin 750 mg single dose plus aminoglycoside intramuscular single dose was suitable option
for empiric prophylaxis in their clinic. Since fluoroquinolones have a broad spectrum of activity
against most gram-negative organisms and a good prostatic tissue penetration, they are widely used
for antibiotic prophylaxis in TRUSBP. However, prolonged use of fluoroquinolones has resulted
in increasing microbial resistance and severe infectious complications. Although some prevention
methods are recommended for reducing the infectious complications after TRUSBP including the
use of fleet enemas or rectal swab with Betadine before the procedure, [2,3] these methods had not
been used in present study. Aminoglycoside is a nephrotoxic agent and it was used in all patients but
there were no information about the creatinine level of patients in present study.
We had been used ciprofloxacin single dose prophlaxis for TRUSBP since the infectious rates
had increased. Fluoroquinolone resistance was detected in 35% of patients admitted to our clinic at
the last three years.
Ongun, et al. [4] compared single dose fosfomycin with single dose levofloxacin and 500 mg
oral ciprofloxacin twice daily administered for 5 days starting 1 day before the procedure in a
retrospective study and Lista, et al. [5] compared double doses of fosfomycin use with 500 mg oral
ciprofloxacin twice daily administered for 5 days starting 1 day before in a prospective randomized
study. Fosfomycin was found to be as safe and effective as ciprofloxacin and levofloxacin in these
two studies. The rate of resistance against fosfomycin is still low despite its clinical use for decades
and there is also no cross-resistance or parallel resistance against fosfomycin and other frequently
used antibiotics. According to these studies we switched the profilactic regimen to a single dose
fosfomycin 3g and we wanted to evaluate its effect by a prospective randomized study. Totally 300
patients were included in the study and divided into two groups. A single dose of fosfomycin (orally,
3 g) the night before the procedure was used as PAP in Group-1 500 mg oral ciprofloxacin 60 min
before the procedure was used as PAP in Group 2. Febrile UTI was not observed in any patient
and afebrile UTI was detected only in 4 patients in the fosfomycin group. None of the patients
presented with infectious complications and required hospitalization in fosfomycin group. Afebrile
UTI rate was higher in ciprofloxacin group. Our results revealed that single dose fosfomycin is as
effective and safe as single dose 500 mg oral ciprofloxacin in the antibiotic prophylaxis for prostate
biopsy. The main advantages of fosfomycin include its simple oral use as single dose and lower cost
compared to intravenous antibiotic prophylaxis regimens.
References
- Unnikrishnan R, El-Shafei A, Klein EA, Jones JS, Kartha G, Goldman HB. For single dosing, levofloxacin Is superior to ciprofloxacin when combined with an aminoglycoside in preventing severe infections after prostate biopsy. Urology. 2015;85(6):1241-6.
- Taylor AK, Zembower TR, Nadler RB, Scheetz MH, Cashy JP, Bowen D, et al. Targeted antimicrobial prophylaxis using rectal swab cultures in men undergopingtransrectal ultrasound guided prostate biopsy is associated with reduced incidence of postoperative infectious complications and cost of care. J Urol. 2012;187(4):1275-9.
- Pu C, Bai Y, Yuan H, Li J, Tang Y, Wang J, et al. Reducing the risk of infection for transrectal prostate biopsy with povidone-iodine: a systematic review and meta-analysis. Int Urol Nephrol. 2014;46(9):1691-8.
- Ongün S, Aslan G, Avkan-Oguz V. The effectiveness of single-dose fosfomycin as antimicrobial prophylaxis for patients undergoing transrectal ultrasound-guided biopsy of the prostate. Urol Int. 2012;89(4):439-44.
- Lista F, Redondo C, Meilán E, García-Tello A, Ramón de Fata F, Angulo JC. Efficacy and safety of fosfomycin-trometamol in the prophylaxis for transrectal prostate biopsy. Prospective randomized comparison with ciprofloxacin. Actas Urol Esp. 2014;38(6):391-6.