STUDY OF NEW ORAL QUINOLONES (LEVOFLOXACIN AND SITAFLOXACIN) AS PROPHYLACTIC ANTIMICROBIAL AGENTS IN TRANSRECTAL PROSTATE NEEDLE BIOPSY

(Objective) A single prophylactic dose of new quinolones is recommended to prevent infection associated with transrectal prostate needle biopsy (TRPB), except in high-risk patients, and a single dose of levofloxacin (LVFX) 500 mg is often administered. We examined single administrations of LVFX and sitafloxacin (STFX), in relation to the frequency of febrile infection. (Patients and methods) The subjects were 411 patients deemed to be suitable candidates for TRPB and ranging in age from 52 to 84 years (median, 75 years). Their PSA values ranged from 3.89 to 2,450 ng/mL (median, 6.92 ng/mL). They were randomly assigned to receive LVFX (group A, 204 patients) or STFX (group B, 207 patients), and the two groups were compared for the incidence of infection with a temperature of 38°C or more within 48 hours after TRPB. (Results) Febrile infection was observed in 8 (3.92%) of the 204 patients in group A and 1 (0.48%) of the 207 patients in group B. Of the 9 patients with febrile infection, 8 had acute prostatitis. There was a significant difference in the incidences of febrile infection between the two groups (p = 0.041; odds ratio, 8.41; 95% confidence interval, 1.04-67.85). The pathogenic bacteria in the 9 patients were Escherichia coli in 7 (Extended-spectrum beta-lactamase [ESBL]-producing bacteria in 3, LVFX-resistant bacteria in 2), Klebsiella pneumoniae in one, and Enterococcus faecalis in one. (Discussion) Measures against quinolone-resistant bacteria, ESBL-producing bacteria, and gram-positive bacteria should be considered for the prevention of infections associated with TRPB. Based on our present observations, STFX is considered to have more favorable effects than LVFX.