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Single Dose Intramuscular Ceftriaxone an Effective Alternative to Accepted Transrectal Prostate Biopsy Prophalaxsis
Ravi Kacker1, Spender Platt2, Micheal Kearney2
1Brigham and Women's Hospital, Boston, MA;2Beth Israel Deaconess Medical Center, Boston, MA
Introduction: Intramuscular Ceftriaxone 1gm given as a single dose immediately prior to transrectal prostate biopsy is an inexpensive, convenient, and effective form of prophylaxsis but currently is not included in the AUA Best Practice Statement and National Quality Forum (NQF) Consensus Standards. We report our experience using intramuscular Ceftriaxone in a multi-language, resident clinic where the rate of noncompliance with standard oral prophylaxsis has been historically high.
Materials & Methods: Retrospective chart review identified 234 men who underwent prostate biopsy between September 2009 and December 2010. 73 of these men received intramuscular Ceftriaxone prior to biopsy in resident clinic, whereas in private clinics at the same center 104 men received prophylaxsis with oral Bactrim plus Ciprofloxacin and 57 men received oral Ciprofloxacin alone. All patients were either seen in follow-up or called one week after biopsy. Infectious and non-infectious complications were determined from the chart.
Results: Of patients who received prophylaxis with oral Ciprofloxacin plus Bactrim and Ciprofloxacin alone, 2 (1.9%) and 1 (1.8%) respectively developed a postoperative febrile infection requiring hospital admission and treatment with intravenous antibiotics. No patients receiving intramuscular Ceftriaxone prophylaxis required admission for any postoperative complication. 1 patient who received Ceftriaxone and 1 patient who received Ciprofloxacin plus Bactrim were treated as outpatients with oral antibiotics for a nonfebrile urinary tract infection.
Conclusions: Bacterial resistance and the potential for noncompliance with patient-controlled prophylaxsis may lead to serious infectious complications after prostate biopsy. Intramuscular ceftriaxone offers a provider-controlled alternative equally effective as standard Methods of surgical prophylaxsis.
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