The Effectiveness of Single-Dose Fosfomycin as Antimicrobial Prophylaxis for Patients Undergoing Transrectal Ultrasound-Guided Biopsy of the Prostate

Objectives: It was the aim of this study to evaluate the efficacy of single-dose fosfomycin prophylaxis as an alternative to fluoroquinolone-based prophylaxis in transrectal ultrasound-guided biopsy of the prostate (TRUSBP). Methods: We evaluated the records of 620 patients who had undergone TRUSBP from January 2010 to July 2011. Patients received a single dose of 3 g oral fosfomycin or a single dose of 500 mg oral levofloxacin or 500 mg oral ciprofloxacin twice daily administered for 5 days starting 1 day before the prophylaxis procedure. We reviewed all febrile and afebrile urinary tract infections (UTIs) within 1 month after TRUSBP. Results: Of the 620 patients, 19 (3.0%) developed febrile UTI and 51 (8.2%) developed afebrile UTI after biopsy. Of the 19 patients with febrile UTI, 1/19 (5.2%) received fosfomycin, 4/19 (21%) received levofloxacin and 14/19 (73.6%) received ciprofloxacin for prophylaxis. Of the 51 patients with afebrile UTI, 4/51 (7.8%) received fosfomycin, 8/51 (15.6%) received levofloxacin and 39/51 (76.4%) received ciprofloxacin for prophylaxis. There were a total of 10 fluoroquinolone-resistant infections, and all of them occurred after the ciprofloxacin or levofloxacin prophylaxis and none after fosfomycin prophylaxis. Conclusions: The ease of use of fosfomycin, reducing the rate of fluoroquinolone-resistant infections and hospitalizations shows that it would be an alternative and effective drug for antimicrobial prophylaxis in TRUSBP. Copyright (c) 2012 S. Karger AG, Basel