From the Guidelines
Prophylactic antibiotics should be administered prior to stone intervention, specifically for procedures like percutaneous nephrolithotomy (PCNL), ureteroscopic stone removal, and open or laparoscopic/robotic stone surgery, based on the most recent evidence from 2024 1. The use of prophylactic antibiotics in kidney stone patients is generally reserved for specific situations where the risk of infection is higher.
- For patients undergoing PCNL, a single dose of antimicrobial prophylaxis appears to reduce the risk of infection, but extended perioperative dosing may be considered in high-risk patients to prevent systemic inflammatory response syndrome (SIRS) 1.
- Ureteroscopy procedures also require prophylactic antibiotics, with options including fluoroquinolones, trimethoprim-sulfamethoxazole, or cephalosporins, to reduce the incidence of postoperative bacteriuria and febrile urinary tract infections 1.
- The choice of antibiotic should be based on prior urine culture results, the local antibiogram, and in consultation with the current Best Practice Policy Statement on Urologic Surgery Antibiotic Prophylaxis 1. Key considerations in the use of prophylactic antibiotics include:
- The risk of antibiotic resistance, which necessitates limited and judicious use of these medications
- The need to protect against procedure-related infections, particularly in patients with infected stones or positive urine cultures
- The importance of selecting antibiotics based on urine culture results, especially in patients with recurrent urinary tract infections associated with stones.
From the Research
Prophylactic Antibiotics for Kidney Stone Treatment
- The use of prophylactic antibiotics in kidney stone treatment is a common practice to prevent surgical site infections and postoperative complications 2, 3, 4, 5, 6.
- Studies have shown that different types of antibiotics, such as ciprofloxacin, cefotaxime, sulbactam-ampicillin, and cefuroxime, can be effective in preventing postoperative infections in patients undergoing percutaneous nephrolithotomy (PCNL) and other endourologic surgeries 2, 3, 4.
Comparison of Antibiotic Regimens
- A study comparing ciprofloxacin and cefotaxime found that a single dose of ciprofloxacin was more effective in preventing postoperative fever in patients undergoing PCNL 2.
- Another study found that single-dose oral ciprofloxacin was equally effective as intravenous cefazolin in preventing postoperative urinary tract infections in patients undergoing outpatient endourologic surgery 3.
- A study comparing sulbactam-ampicillin and cefuroxime found that both antibiotics were safe and effective for prophylaxis in PCNL, and that single-dose administration was sufficient 4.
Duration and Timing of Antibiotic Prophylaxis
- The American Urological Association (AUA) and European Association of Urology (EAU) guidelines recommend a risk-adapted minimal antibiotic usage, with single-dose antibiotic prophylaxis being sufficient for low-risk PCNL and ureterorenoscopy (URS) 5.
- A study found that pre-operative prophylaxis with a single-dose antibiotic was sufficient in patients with negative urine culture, and that pre-operative treatment with antibiotics according to the bacterial sensitivity pattern should be administered for ≥7 days in patients with positive urine culture 6.
Urine and Stone Culture Results
- Studies have shown that positive urine and stone culture results are associated with an increased incidence of postoperative infections, and that antibiotic treatment should be tailored according to these results 4, 6.
- A study found that a positive stone culture was associated with an increased incidence of infection, even if the patient had a negative urine culture and urine test 6.