The Issue of Prophylactic Antibiotics prior to Flexible Cystoscopy

Should We Use Antibiotic Prophylaxis for Flexible Cystoscopy? A Systematic Review and Meta-Analysis

“…1). Full manuscripts were evaluated in 12 studies, of which 7 were included into the review [7,11,12,13,17,18,19]. The studies were published between 1971 and 2013, reflecting the time-tested, unanswered question of prophylactic use of antibiotics for FC.…”

“…Seven studies were included [7,11,12,13,17,18,19]. All studies included participants who were for surveillance or diagnostic cystoscopy with a normal urinary tract.…”

“…Six of the studies administered a single dose of antibiotic approximately one hour before FC [7,11,12,13,17,19]. Five studies for each group reported numbers of confirmed bacteriuria on MSU [7,11,12,17,18], asymptomatic bacteriuria [11,13,17,18,19] and symptomatic bacteriuria [11,12,13,17,19]. Three studies performed questionnaire follow-up to assess urinary symptoms [11,12,19] and one study hospitalised patients for the duration of the study to monitor objective parameters, which was the routine practice at that time [18].…”

“…Oral Ciprofloxacin (500 mg), Trimethoprim (200 mg), Levofloxacin (500 mg), Norfloxacin (400 mg), Fosfomycin Trometamol (3 g) were used in different trials and showed similar results. The intramuscular route was used in two trials: Gentamicin [7] and Ceftriaxone [13]. One study administered an extended course of antibiotics, which were either oral Demeclocycline Hydrochloride (150 mg dose 4 times a day for 4 days) or Sulfamethoxypyridazine (initially 1 g, then 500 mg once daily for three days) [18].…”

“…Urinary tract infection (UTI) after cystoscopic procedures has a reported incidence ranging from 2.7-35%, of which 10-16% patients can go on to develop septicaemia [4,5,6,7,8]. Given the risk of UTI, the use of prophylactic antibiotics prior to flexible cystoscopy (FC) has been suggested; however, supportive evidence has been inconclusive.…”