Is antibiotic prophylaxis required for flexible cystoscopy? A truncated randomized double-blind controlled trial.
OBJECTIVE
To examine the incidence of urinary tract infection (UTI) after flexible cystoscopy (FC) and determine whether prophylactic norfloxacin reduces this incidence compared with placebo.


METHODS
A double-blind trial was performed, randomizing 234 patients to either 400 mg of norfloxacin or placebo prior to FC. All patients provided a midstream urine specimen (MSU) before the procedure, as well as at day 3 and day 7 after FC. In addition, a telephone questionnaire was performed to correlate the nature and severity of any symptoms associated with UTI.


RESULTS
Interim analysis was performed because of the low recruitment rate, and a significantly lower infection rate than expected meant that the trial was discontinued. There was one symptomatic UTI in the placebo group (0.82%) and one in the norfloxacin group (0.89%). The UTI in the placebo group was de novo, while the infection in the norfloxacin group was secondary to pre-FC bacteriuria. There was no difference in the infection rates in the two groups. The overall infection rate (de novo and secondary to existing bacteruria) after FC was 0.85%.


CONCLUSIONS
Infection after flexible cystoscopy is rare and not associated with significant morbidity. A much larger study would be required to determine whether antibiotic prophylaxis significantly reduces the rate of postprocedure UTI.
Wilson
L
L
Department of Urology, Auckland City Hospital, Auckland, New Zealand. liam@liam-wilson.com
Ryan
J
J
Thelning
C
C
Masters
J
J
Tuckey
J
J
D000890:Anti-Infective Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D001437:Bacteriuria / Q000209:etiology; D003558:Cystoscopy / Q000379:methods*; D004311:Double-Blind Method; D016983:Enterococcus; D005260:Female; D006801:Humans; D008297:Male; D009643:Norfloxacin / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000517:prevention & control*; D014552:Urinary Tract Infections / Q000517:prevention & control*
D000890:Anti-Infective Agents; D009643:Norfloxacin