THE VALUE OF ANTIBIOTIC-PROPHYLAXIS DURING EXTRACORPOREAL SHOCK-WAVE LITHOTRIPSY IN THE PREVENTION OF URINARY-TRACT INFECTIONS IN PATIENTS WITH URINE PROVEN STERILE PRIOR TO TREATMENT

Introduction: There are controversies in the literature regarding the need for and duration of antibiotic prophylaxis in patients treated wi th extracorporeal shock wave lithotripsy (ESWL) who have a negative ur ine culture before treatment. In order to determine the efficacy of an tibiotic prophylaxis in ESWL treatment of patients with proven sterile urine, a radnomized trial was performed. Methods: Patients were rando mized for placebo and 1 or 7 days antibiotic prophylaxis (cefuroxime o r ciprofloxacin), starting 30 min before ESWL. Post-ESWL studies (imme diately and 2 and 6 weeks after ESWL) included patient history, urine culture and Gram stain. Results: After 2 weeks 20% of the patients and after 6 weeks 23% of the patients had bacteriuria, but there was no s tatistical significance between patients treated with placebo or those receiving prophylactic treatment. Only 2-3% of the patients (in the p rophylaxis and placebo group) had clinical and bacteriological signs o f a urinary tract infection, either 2 or 6 weeks after ESWL, possibly caused by re-infection, however, since bacteria were found in none of the urine samples collected directly after ESWL. There was no benefici al effect of antibiotic prophylaxis in the prevention of urinary tract infections in patients with a nephrostomy catheter or dilatation at t he site of treatment. Conclusion: We conclude that in patients with ur ine proven sterile prior to ESWL there is no need for antibiotic proph ylaxis.