Table 1 Overview of guidelines on the prevention of infectious complications after transrectal prostate biopsy
Recommendations | EAU guidelines on prostate cancer [2] | EAU guidelines on urological infections [5] | AUA guidelines [4] | |
|---|---|---|---|---|
First choice antimicrobial prophylaxis | Fluoroquinolones with ciprofloxacin being superior to ofloxacin | Debatable, most commonly FQ are applied | Fluoroquinolones or 1st/2nd/3rd gen. Cephalosporin | Fluoroquinolones |
Alternative antimicrobial prophylaxis | Not mentioned | Fosfomycin trometamola | Co-trimoxazole or Aminoglycoside (Aztreonam) | If recent culture shows FQ resistance: antibiotics based on the resistance pattern, preferably co-trimoxazole |
Duration of prophylaxis | Not mentioned | Debatable, meta-analysis by the guideline panel ongoing | ≤ 24 h | Single dose |
Timing of prophylaxis | Not mentioned | Not mentioned | ≥ 1 h before prostate biopsy | Not mentioned |
Culture-guided prophylaxis | Regional and local resistance patterns should be taken into account when deciding on the choice of antibiotics | Mentioneda | Not mentioned | There is no indication to routinely perform a urine or rectum culture |
Topical preparation | Rectal disinfection with povidone-iodine may be considered. | Use rectal cleansing with povidone-iodine | No standard for topical preparation has been established | Not mentioned |