Short-term antibiotic prophylaxis regimens—including fosfomycin trometamol, ciprofloxacin, or their combination—show similar effectiveness in preventing infectious complications after transrectal ultrasound-guided prostate biopsy, according to findings from a prospective randomized study. The research evaluates infection rates following the procedure, which remains a primary diagnostic tool for prostate cancer, the most common malignant solid tumor in men older than 70.
During the monitored period between January 2021 and December 2022, researchers evaluated 605 prostate biopsies, with 544 patients meeting the inclusion criteria for the study. Patients were randomized into three distinct groups based on their prophylactic antibiotic regimen before and after the procedure.
Comparing Antibiotic Regimens and Infection Rates
To determine the efficacy of different protocols, the prospective trial divided participants into three specific dosing schedules. Group 1 received 3 grams of fosfomycin trometamol three hours before the procedure combined with 500 milligrams of ciprofloxacin two hours prior. Group 2 received 3 grams of fosfomycin trometamol three hours before and 24 hours after the biopsy. Group 3 received 500 milligrams of ciprofloxacin 12 hours before, two hours before, and 12 hours after the procedure.
According to the study results, researchers divided the 544 qualifying participants into 184 patients in group 1, 161 in group 2, and 199 in group 3. To evaluate pre-existing flora, a rectal swab was performed one to two weeks before the biopsy. Follow-up visits within one month of the procedure tracked any resulting complications.
Infectious complications occurred in a total of 10 cases, representing an overall rate of 1.83%. When broken down by cohort, infections occurred in 3 patients in group 1, 4 patients in group 2, and 3 patients in group 3. Statistical analysis revealed no significant difference in complication rates between the individual regimens.
Clinical Implications and Patient Safety
None of the patients who developed infections required hospitalization, and all remained free of sepsis symptoms during the follow-up window. The data indicates that short-term prophylaxis using these specific antibiotics or combinations successfully minimizes post-biopsy risks without severe adverse outcomes in this patient population.
The findings support the clinical utility of fosfomycin trometamol as a viable alternative to traditional fluoroquinolone antibiotics like ciprofloxacin.
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