J Med Assoc Thai 2017; 100 (5):528

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A Comparative Study of Oral Medication to Prevent Transient Bacteremia and Adverse Events from Transrectal Prostatic Biopsy: Ciprofloxacin versus Cefixime
Pipitpanpipit T , Santanirand P , Kongchareonsombat W Mail

Objective: To study the transient bacteremia and adverse events of changing antibiotic prophylaxis from oral ciprofloxacin to oral cefixime in (patients) undergoing transrectal prostatic biopsy.

Material and Method: One hundred patients with suspected prostate cancer underwent outpatient surgery at Ramathibodi Hospital were randomly assigned to two groups. The first group was prescribed oral ciprofloxacin, and the second group received oral cefixime. Blood culture tests were routinely performed within 24 hours after transrectal prostatic biopsy in all patients, and they were monitored for adverse reactions over a 14-day period.

Results: Transient bacteremia was detected in 2% of the participants in the group with oral cefixime, and none in the group receiving oral ciprofloxacin, but the rate of transient bacteremia of the two groups was no varied with statistical significance (p>0.05). Adverse effects, including acute urinary retention (AUR), hematuria, rectal bleeding, vasovagal syncope, and hematospermia, were found in both patient groups after the procedure. They did not differ significantly (p>0.05). Dysuria was found in the group treated with oral cefixime and it differ significantly (p<0.05).

Conclusion: Cefixime is likely not the antibiotic of choice compared with ciprofloxacin in preventing post-transrectal prostatic biopsy transient bacteremia, and it appears to show a high rate of dysuria after transrectal prostatic biopsy. Until a more suitable, effective oral prophylactic agent is found, quinolone-based antibiotics should be the antibiotic of choice for patient undergoing transrectal prostatic biopsy.

Keywords: Antibiotic prophylaxis; transrectal prostatic biopsy; ciprofloxacin; cefixime; transient bacteremia

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