A RANDOMIZED PROSPECTIVE COMPARISON OF ANTIBIOTIC TISSUE-LEVELS IN THE CORPORA CAVERNOSA OF PATIENTS UNDERGOING PENILE PROSTHESIS IMPLANTATION USING GENTAMICIN PLUS CEFAZOLIN VERSUS AN ORAL FLUOROQUINOLONE FORPROPHYLAXIS

Purpose: We performed a prospective randomized trial comparing the eff icacy, safety and cost of parenteral antibiotics and oral fluoroquinol ones for prophylaxis in penile prosthesis surgery. Materials and Metho ds: We prospectively randomized 20 consecutive patients undergoing pen ile prosthesis surgery to receive ofloxacin orally or gentamicin and c efazolin parenterally followed by cephradine orally. Intraoperatively corpora cavernosa tissue and simultaneous peripheral serum samples wer e evaluated for antibiotic levels. Median followup was 16 months (rang e 8 to 21, mean 15.35). Results: There were no implant losses or reope rations and complications were comparable in the 2 groups. The differe nce in mean serum-to-tissue ratios of ofloxacin versus the combination of cefazolin and gentamicin was statistically significant (p <0.03). The minimum inhibitory concentrations of ofloxacin met or exceeded tho se of the 2 most common offending organisms, Staphylococcus epidermidi s and Escherichia coli, in 80% of patients, which was comparable to th e results of the parenteral regimen. Cost savings of the medications a lone were more than $250,000 in the ofloxacin group. By eliminating a hospital stay of the 25,000 cases of penile prosthesis placement in th e United States yearly a total cost savings of more than $36 million w ould be realized. Conclusions: When oral ofloxacin is given for prophy laxis in penile implant surgery, the procedure may be performed on an outpatient basis and health care dollars are saved.