Oral ciprofloxacin or trimethoprim reduces bacteriuria after flexible cystoscopy.
OBJECTIVE
To report a large prospective, pragmatic, double-blind randomized controlled trial to determine whether oral prophylactic antibiotics reduce the risk of bacteriuria after flexible cystoscopy (FC), as up to 10% of patients develop urinary infection afterwards, with significant morbidity and costs for health services.


METHODS
In all, 2481 patients were recruited into a three-arm placebo controlled trial and 2083 completed it. Patients were randomly assigned to one of three treatments; (i) placebo; (ii) one oral dose of trimethoprim (200 mg); or (iii) one oral dose of ciprofloxacin (500 mg), each administered 1 h before a FC under local anaesthetic. A mid-stream urine specimen was taken before and 5 days after FC; significant bacteriuria was defined as a pure growth of >10(5) colony-forming units/mL.


RESULTS
The rate of bacteriuria after FC was reduced from 9% in the placebo group to 5% and 3% in patients receiving trimethoprim and ciprofloxacin prophylaxis, respectively. When rates of bacteriuria before FC were considered the odds of developing bacteriuria after FC relative to baseline were 5, 2 and 0.5 for placebo, trimethoprim and ciprofloxacin, respectively.


CONCLUSIONS
This large trial shows clearly that one dose of oral ciprofloxacin significantly reduces bacteriuria after FC.
Johnson
Mark I
MI
Freeman Hospital, Newcastle upon Tyne, UK.
Merrilees
David
D
Robson
Wendy A
WA
Lennon
Teresea
T
Masters
John
J
Orr
Kathy E
KE
Matthews
John N S
JN
Neal
David E
DE
D000284:Administration, Oral; D000328:Adult; D000892:Anti-Infective Agents, Urinary / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D001437:Bacteriuria / Q000517:prevention & control*; D002939:Ciprofloxacin / Q000627:therapeutic use*; D003558:Cystoscopy / Q000009:adverse effects*; D004311:Double-Blind Method; D006801:Humans; D011446:Prospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014295:Trimethoprim / Q000627:therapeutic use*