ANTIBIOTIC-PROPHYLAXIS FOR PATIENTS UNDERGOING TRANSURETHRAL RESECTION OF THE PROSTATE

Objectives. To evaluate the prevention of urinary tract infections (UT Is) after transurethral resection of the prostate (TURF) in a prospect ive randomized study using. quinolone antibiotic (fleroxacin) to compa re the efficacy of: (1) a single oral dose, (2) a single intravenous ( IV) dose, and (3) an extended regimen consisting of an initial IV dose followed by oral therapy until removal of the urinary catheter, but f or less than 6 days. Methods. We excluded from study patients who rece ived antimicrobial agents within 48 hours of surgery. Single-dose prop hylaxis consisted of 400 mg of fleroxacin given either orally or intra venously. The extended regimen consisted of an initial 400 mg IV dose followed by 400 mg oral each day (patients older than 75 years, or wit h a creatinine clearance less than 40 mL/min, received 200 mg/day). UT I was defined as clinical evidence of infection plus the presence of m ore than 10 white blood cells (WBC)/mm(3) in any urine specimen plus t he presence of more than 10(4) cfu/mL in midstream urine specimens or more than 10(2) cfu/mL in catheter specimens. Results. Prior to TURP, 30% (25/84) of the patients had a urethral catheter in situ and 12% (3 /25) of these patients had bacteriuria. Only 1 patient developed a UTI and that was 22 days after a TURF (intergroup comparisons, Fisher's e xact test greater than 0.05). There were no instances of urosepsis. Co nclusions. A single oral dose of a fluoroquinolone agent provided opti mum prophylaxis for patients undergoing TURP.