Use of fosfomycin as targeted antibiotic prophylaxis before prostate biopsy: A prospective randomized study

Abstract

Objectives To investigate whether switching ciprofloxacin to fosfomycin in the case of fluoroquinolone‐resistant rectal bacteria influences the incidence of infectious complications after transrectal prostate biopsy. Methods From December 2015 until December 2017, patients undergoing prostate biopsy were randomly assigned to a control group or an intervention group in a prospective, open‐label fashion at three different centers. The presence of fluoroquinolone‐resistant organisms was detected by rectal swabs. Patients in the control group received ciprofloxacin. Patients in the intervention group received fosfomycin instead of ciprofloxacin in the case of fluoroquinolone‐resistant bacteria on rectal swab culture. The primary end‐point was the difference in occurrence of major (febrile) and minor (afebrile) infections between both groups. Results A total of 102 patients were randomized to the control group, and 102 patients to the intervention group. In the control group, nine complications occurred, of which five were major febrile complications. In the intervention group, six complications occurred, of which four were major febrile complications. The total number of complications (major and minor) did not differ between both groups (P = 0.59). A subgroup analysis of patients with fluoroquinolone‐resistant bacteria on rectal swab showed five complications in the control group and one complication in the intervention group (P = 0.09). Conclusions This represents the first prospective randomized study using rectal cultures for targeted antibiotic prophylaxis. Study findings show promising results for use of fosfomycin in patients with fluoroquinolone resistance.

Comparison of Complication Rates with Antibiotic Prophylaxis with Cefpodoxime Versus Fluoroquinolones After Transrectal Prostate Biopsy

“…Since the European Medicines Agency (EMA) recommended more restrictive use of fluoroquinolones because of potentially permanent side effects, several studies have compared the efficacy of antibiotic prophylaxis for prostate biopsy with different antibiotic regimes [12][13][14][15][16]. To the best of our knowledge, no previous study has explicitly investigated complication rates after prostate biopsy with cefpodoxime as oral antibiotic prophylaxis.…”

Comparison of Double Dose Fosfomycin and Ciprofloxacin in The Prophylaxis of Transrectal Ultrasound Guided Prostate Biopsy

“…Fosfomisin, komplike olmayan alt üriner sistem enfeksiyonlarının tedavisinde kullanılan çok çeşitli Gram-pozitif ve Gram-negatif mikroorganizmalara etkili, kullanımı kolay olan ve iyi tolere edilen geniş spektrumlu oral antibiyotiktir. Fosfomisinin erkeklerde prostat dokusunda terapötik konsantrasyona ulaşması nedeniyle prostat biyopsisine bağlı enfeksiyonların önlenmesinde kullanılabileceğine dair çalışmalar yayınlanmıştır (14).…”

Editorial Comment from Dr Macdonald and Dr Roberts to Use of fosfomycin as targeted antibiotic prophylaxis before prostate biopsy: A prospective randomized study

“…Van Besien et al . carried out a prospective cohort study to compare FT as targeted TRUSPB prophylaxis in patients with FQ‐resistant rectal culture against FQ in 204 patients . Higher rates of major (9% vs 4%) and minor (23% vs 4%) infection were reported for the FQ‐only group compared with the FQ/FT group.…”