Antibiotic prophylaxis for prostate biopsy: benefits and costs

Abstract

Transrectal ultrasound-guided core biopsy is a widely used method to diagnose prostate cancer. It is generally considered a safe procedure but the main concern is that signi®cant complications such as infections do occur. To evaluate the effect of a combined two-dosage antibiotic prophylaxis with cipro¯oxacin and metronidazole, a prospective study of 289 patients undergoing core-biopsy of the prostate was performed. Five patients (1.7%) developed urinary tract infection and all did recover without any further complications. The infection rate was signi®cantly lower compared to our historic controls receiving no prophylaxis at all. This prophylactic regime resulted in a low infection rate and it was feasible from the patient perspective. The total cost of antibiotic medication and additional costs due to complications was 18 USD per patient and the cost-effectiveness compared to no prophylactic therapy at all was considered good.

Ultrasound-guided transrectal extended prostate biopsy: a prospective study

“…Recently, it was reported that there is no clinical or statistical difference between the 1-day and 3-day antibiotic prophylaxis regimen for patients undergoing TRUS-guided prostate biopsy [20]. Larsson et al [21] concluded that no prophylactic therapy was considered good.…”

Prevalence of antimicrobial resistance in intestinal flora of patients undergoing prostatic biopsy: implications for prophylaxis and treatment of infections after biopsy

“…The role of antimicrobial prophylaxis for preventing infections after TRUS‐guided prostate biopsy (TGB) is well established [1,2]. Although a wide variety of antimicrobial regimes has been suggested, fluoroquinolones are the most commonly used antimicrobials for prophylaxis for these procedures [3].…”

Impact of improvement in specificity of primary screening test on total cost of prostate cancer mass screening

“…The cost of biopsy and the cost of management of biopsy complications were assumed to be $150 and $500, respectively, as reported by Ellison et al 16 . and Larsson et al 17 . The sensitivity and specificity of conventional PSA were assumed to be 0.95 and 0.10, respectively, based on an excellent review by Roddam et al 6 .…”

“…Carey et al 15 The cost of biopsy and the cost of management of biopsy complications were assumed to be $150 and $500, respectively, as reported by Ellison et al 16 and Larsson et al 17 The sensitivity and specificity of conventional PSA were assumed to be 0.95 and 0.10, respectively, based on an excellent review by Roddam et al 6 The prevalence of prostate cancer was assumed to be 0.03 in Thompson's reports 18,19 in addition to the reports on prostate cancer screening programs worldwide (Table 1). In the decision tree model, the probability of a positive primary screening test (Ppositive primary screening test) was calculated as:…”