Do preprostate biopsy enemas help prevent infection?

  • Su R & al.
  • Eur J Clin Microbiol Infect Dis
  • 27 Mar 2019

  • International Clinical Digest
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Takeaway

  • A new study affirms that a single 500-mg dose of levofloxacin (Levaquin) without enema is effective for preventing infection in most patients undergoing transrectal ultrasound (TRUS)-guided prostate biopsy.
  • Those at high risk for infection should receive a 3-day regimen.

Why this matters

  • Prebiopsy enema is unnecessary, providing no clinically significant advantage.

Study design

  • Patients undergoing TRUS-guided prostate biopsy (N=420) were randomly allocated into 3 treatment groups:
    • Group A received 500 mg levofloxacin without enema.
    • Group B received 500 mg levofloxacin plus enema.
    • Group C (control) received 3-day levofloxacin plus enema.
  • Patients assessed for febrile urinary tract infection (FUTI) if symptoms developed within 2 weeks after biopsy.
  • Funding: Ningbo Natural Science Fund; Zhejiang Natural Science Fund.

Key results

  • 15 patients developed FUTI: 7 from group A (5%), 6 from group B (4.3%), and 2 from group C (1.4%).
  • Among high-risk patients, FUTI incidence was significantly higher in group A than in group C (P=.015).
  • Infection rates did not differ between groups A and B, whether patients were high- or low-risk.

Limitations

  • Single center, with a small sample size and few high-risk patients.
  • All patients were from eastern China; results may not apply to other populations.