From the Guidelines
Cephalosporin group 2 or 3 antibiotics are recommended post-operatively to prevent prostate infection after Transurethral Resection of the Prostate (TURP). The choice of antibiotic is crucial in preventing post-operative infections, and according to the European Association of Urology guidelines on urological infections, published in 2024 1, Cephalosporin group 2 or 3 are the suggested antimicrobial prophylaxis regimens for TURP. Some key points to consider when choosing an antibiotic regimen include:
- The patient's allergy history, particularly to penicillin or cephalosporins
- Local resistance patterns, which may influence the effectiveness of certain antibiotics
- The patient's overall health status and risk factors for infection
- The potential for antibiotic side effects and interactions with other medications The European Association of Urology guidelines provide a comprehensive overview of antimicrobial prophylaxis regimens for various urological procedures, including TURP, and are based on the latest evidence and expert consensus 1. In clinical practice, it is essential to weigh the benefits and risks of antibiotic prophylaxis and to consider the potential for antibiotic resistance and side effects when selecting a regimen. Some alternative antibiotics, such as trimethoprim-sulfamethoxazole or fluoroquinolones, may be considered in certain situations, but Cephalosporin group 2 or 3 remain the recommended first-line choice for TURP 1.
From the FDA Drug Label
Perioperative Prophylaxis: The prophylactic administration of Cefazolin for Injection, USP preoperatively, intraoperatively, and postoperatively may reduce the incidence of certain postoperative infections in patients undergoing surgical procedures which are classified as contaminated or potentially contaminated... Genital Infections: (i.e., prostatitis, epididymitis) due to E. coli, P. mirabilis.
The antibiotic Cefazolin is used post-operatively to prevent prostate infection after Transurethral Resection of the Prostate (TURP) 2.
- Key points:
- Cefazolin is effective against E. coli and P. mirabilis, which can cause genital infections including prostatitis.
- The prophylactic administration of Cefazolin may reduce the incidence of certain postoperative infections in patients undergoing surgical procedures.
From the Research
Antibiotics Used Post-Operatively to Prevent Prostate Infection after TURP
- The use of antibiotic prophylaxis is recommended for all patients undergoing Transurethral Resection of the Prostate (TURP) to prevent postoperative urinary tract infections 3, 4, 5, 6, 7.
- Various antibiotic regimens have been used, including ciprofloxacin, cefazolin, and gentamicin 3.
- A study found that ciprofloxacin was the most commonly prescribed single antibiotic regimen, accounting for 32% of prescriptions, followed by cefazolin (25%) and gentamicin (3%) 3.
- Another study compared the efficacy of different antibiotic prophylaxis regimens, including a single oral dose, a single intravenous dose, and an extended regimen, and found that a single oral dose of a fluoroquinolone agent provided optimum prophylaxis for patients undergoing TURP 7.
- The choice of antibiotic prophylaxis may depend on various factors, including the presence of a preoperative catheter or pyuria, and the risk of microbial resistance 5.
- Some studies have suggested that single-dose antibiotic prophylaxis may be non-inferior to 3-day prophylaxis in patients undergoing TURP or Greenlight laser vaporisation of the prostate 6.
Specific Antibiotic Regimens
- Ciprofloxacin: a fluoroquinolone antibiotic that has been shown to be effective in preventing postoperative urinary tract infections after TURP 3, 7.
- Cefazolin: a cephalosporin antibiotic that has been used as a single antibiotic regimen for TURP 3.
- Gentamicin: an aminoglycoside antibiotic that has been used in combination with other antibiotics for TURP 3.
- Cotrimoxazole: a combination antibiotic that has been used for prophylaxis in TURP and Greenlight laser vaporisation of the prostate 6.