The value of antibiotic prophylaxis during extracorporeal shock wave lithotripsy in the prevention of urinary tract infections in patients with urine proven sterile prior to treatment.
BACKGROUND
There are controversies in the literature regarding the need for and duration of antibiotic prophylaxis in patients treated with extracorporeal shock wave lithotripsy (ESWL) who have a negative urine culture before treatment. In order to determine the efficacy of antibiotic prophylaxis in ESWL treatment of patients with proven sterile urine, a randomized trial was performed.


METHODS
Patients were randomized for placebo and 1 or 7 days antibiotic prophylaxis (cefuroxime or ciprofloxacin), starting 30 min before ESWL. Post-ESWL studies (immediately and 2 and 6 weeks after ESWL) included patient history, urine culture and Gram stain.


RESULTS
After 2 weeks 20% of the patients and after 6 weeks 23% of the patients had bacteriuria, but there was no statistical significance between patients treated with placebo or those receiving prophylactic treatment. Only 2-3% of the patients (in the prophylaxis and placebo group) had clinical and bacteriological signs of a urinary tract infection, either 2 or 6 weeks after ESWL, possibly caused by re-infection, however, since bacteria were found in none of the urine samples collected directly after ESWL. There was no beneficial effect of antibiotic prophylaxis, in the prevention of urinary tract infections in patients with a nephrostomy catheter or dilatation at the site of treatment.


CONCLUSIONS
We conclude that in patients with urine proven sterile prior to ESWL there is no need for antibiotic prophylaxis.
Bierkens
A F
AF
Department of Urology, Academic Hospital Nijmegen, The Netherlands.
Hendrikx
A J
AJ
Ezz el Din
K E
KE
de la Rosette
J J
JJ
Horrevorts
A
A
Doesburg
W
W
Debruyne
F M
FM
D000284:Administration, Oral; D000890:Anti-Infective Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D002444:Cefuroxime / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use; D002511:Cephalosporins / Q000008:administration & dosage / Q000627:therapeutic use*; D002939:Ciprofloxacin / Q000008:administration & dosage / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007275:Injections, Intravenous; D008096:Lithotripsy; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013997:Time Factors; D014514:Ureteral Calculi / Q000628:therapy*; D014552:Urinary Tract Infections / Q000517:prevention & control*
D000890:Anti-Infective Agents; D002511:Cephalosporins; D002939:Ciprofloxacin; D002444:Cefuroxime; C040738:cefuroxime axetil