Reduction in Hospital Admissions With the Addition of Prophylactic Intramuscular Ceftriaxone Before Transrectal Ultrasonography–guided Prostate Biopsies

Objective To evaluate the hospitalization rates in 2 pre–prostate biopsy antibiotic protocols. Methods Two prebiopsy protocols were compared. CiproAlone required ciprofloxacin 500 mg twice daily starting 1 day before biopsy and continuing for 3 days after biopsy (4 days total). Diabetic patients were prescribed ciprofloxacin for 4 days after biopsy. CiproCeft required 1 dose of oral ciprofloxacin 500 mg 1 hour before the biopsy and ceftriaxone 1 g intramuscular at the time of the biopsy. Hospitalization rates between the CiproAlone vs CiproCeft protocols were examined. Results A total of 4134 biopsies were identified—2093 in the CiproAlone cohort and 2041 in the CiproCeft cohort. The post–prostate biopsy infection hospitalization rate was 0.6% (14 patients) in the CiproAlone group vs 0.0% (0 patients) in the CiproCeft group ( P P  = .01) in our population, but there was no difference between the 2 groups in the rates of diabetes mellitus ( P  = .46). Patient age, prostate-specific antigen level, number of biopsy cores obtained, race, and previous antibiotics exposure were not found to be independent predictors of post–transrectal ultrasonography biopsy hospitalization for infection using a multivariate regression analysis. Conclusion A prophylactic prebiopsy protocol including 2 classes of antibiotics, single-dose ciprofloxacin, and singe-dose intramuscular ceftriaxone reduced post–transrectal ultrasonography biopsy rates of hospitalizations compared to oral ciprofloxacin alone.