What antibiotic prophylaxis is recommended post Double J (DJ) stenting?

Antibiotic Prophylaxis After Double J (DJ) Stent Placement

For most patients with DJ stents, a single dose of perioperative antibiotic prophylaxis is sufficient, and continuous antibiotic therapy is not recommended. 1, 2

First-Line Antibiotic Options for DJ Stent Prophylaxis

• A single dose of a fluoroquinolone (ciprofloxacin 500 mg, levofloxacin 500 mg, or ofloxacin 400 mg) is recommended as an oral prophylactic option for DJ stent placement 3, 4
• Alternative intravenous options include:
  • Ceftriaxone (1-2 g IV single dose) 3, 4
  • Ampicillin/sulbactam (1.5-3 g IV) 3, 4
  • Gentamicin (5 mg/kg IV single dose) 3

Evidence Against Continuous Antibiotic Prophylaxis

• Multiple randomized clinical trials have demonstrated that continuous low-dose antibiotic treatment does not reduce:
  • Urinary tract infection rates compared to single-dose perioperative prophylaxis 1, 2
  • Stent-related symptoms 5, 1, 2
  • Bacterial colonization of DJ stents 5
• Continuous antibiotic use may increase antibiotic side effects and promote antimicrobial resistance 5, 2

Special Considerations for High-Risk Patients

• For immunocompromised patients (those with inflammatory arthropathies, drug-induced immunosuppression, radiation-induced immunosuppression, HIV/AIDS, active malignancy, or transplant recipients), consider more aggressive prophylaxis 3, 6
• Ensure urine is sterile before DJ stent placement; if bacteriuria is present, the risk of bacteremia increases dramatically, and antibiotic treatment of the bacteriuria is required before stent placement 3, 4
• For patients with purulent urine encountered during the procedure:
  • Abort the procedure if possible
  • Establish appropriate drainage
  • Culture the purulent urine
  • Continue broad-spectrum antibiotics pending culture results 4

Timing of Antibiotic Administration

• Administer oral antibiotics 1-2 hours before the procedure 6
• Administer intravenous antibiotics 30-60 minutes before the procedure 6

Management of Infected DJ Stents

• For infected DJ stents with systemic symptoms, consider:
  • Amoxicillin plus an aminoglycoside
  • A second-generation cephalosporin plus an aminoglycoside
  • An intravenous third-generation cephalosporin 4
• Treatment duration should be 7-14 days, with 14 days recommended for men when prostatitis cannot be excluded 4

Prevention of Recurrent Infections

• Periodically reassess the need for DJ stents to determine whether removal is possible, as the main risk factor for infection is the duration of stent placement 4
• Non-antibiotic approaches like cranberry extract may reduce urinary tract colonization but have not shown significant clinical benefit in reducing symptomatic infections 5

Common Pitfalls to Avoid

• Avoid routine use of continuous antibiotics for all patients with DJ stents, as this practice does not improve outcomes and may contribute to antibiotic resistance 5, 1, 2
• Do not neglect to screen for and treat bacteriuria before stent placement 3, 4
• Remember that bacterial biofilms can form on stents, making infections more resistant to treatment if they occur 4