title: For Single Dosing, Levofloxacin Is Superior to Ciprofloxacin When Combined With an Aminoglycoside in Preventing Severe Infections After Prostate Biopsy.
abstract: OBJECTIVE
  To investigate whether there is benefit with a longer acting oral fluoroquinolone, we compared the rate of infection after transrectal ultrasound-guided prostate biopsy between 2 prophylactic antibiotic regimens: ciprofloxacin vs levofloxacin, each combined with an aminoglycoside (AG).
  
  
  METHODS
  A retrospective review was performed of all transrectal ultrasound-guided prostate biopsies from September 2011 to January 2013. Initially our regimen entailed 1 dose of 500-mg ciprofloxacin and an AG. In June 2012, we switched to 1 dose of 750-mg levofloxacin and an AG. Infections were categorized as severe if requiring hospital admission, overnight observation, or emergency room treatment for fever or chills. Those treated as an outpatient were defined as mild.
  
  
  RESULTS
  Of 1189 total biopsies, the total infection rate was 3.18% (17 of 535) in the ciprofloxacin group and 2.14% (14 of 654) in the levofloxacin group (P = .26). The rate of mild infection was 0.75% (4 of 535) in the ciprofloxacin group and 1.22% (8 of 654) in the levofloxacin group (P = .56). The rate of severe infection was significantly higher in the ciprofloxacin group at 2.43% (13 of 535) compared with that of 0.92% (6 of 654) in the levofloxacin group (P = .04). On multivariate analysis, use of ciprofloxacin rather than levofloxacin was associated with an increased risk of severe infection (odds ratio, 4.59; P = .04).
  
  
  CONCLUSIONS
  Empiric prophylaxis for prostate biopsies with a single-dose fluoroquinolone augmented with an AG is optimal to reduce infectious complications. We found 750-mg levofloxacin resulted in significantly fewer severe infections compared with 500-mg ciprofloxacin potentially because of its longer half-life.
authors: Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH. Electronic address: unnikrr@ccf.org.
authors: Raman
authors: R
authors: Unnikrishnan
authors: Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH; Department of Urology, Al Kasr Al Aini School of Medicine, Cairo University, Giza, Egypt.
authors: Ahmed
authors: A
authors: El-Shafei
authors: Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH.
authors: Eric A
authors: EA
authors: Klein
authors: Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH.
authors: J Stephen
authors: JS
authors: Jones
authors: Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH.
authors: Ganesh
authors: G
authors: Kartha
authors: Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH.
authors: Howard B
authors: HB
authors: Goldman
mesh_terms: D000617:Aminoglycosides / Q000008:administration & dosage*; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D019072:Antibiotic Prophylaxis; D001424:Bacterial Infections / Q000517:prevention & control*; D002939:Ciprofloxacin / Q000008:administration & dosage*; D004359:Drug Therapy, Combination; D024841:Fluoroquinolones / Q000008:administration & dosage*; D006801:Humans; D061705:Image-Guided Biopsy / Q000379:methods; D064704:Levofloxacin / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control*; D011467:Prostate / Q000000981:diagnostic imaging / Q000473:pathology*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D018084:Ultrasonography, Interventional
chemical_list: D000617:Aminoglycosides; D000900:Anti-Bacterial Agents; D024841:Fluoroquinolones; D002939:Ciprofloxacin; D064704:Levofloxacin