From the Guidelines
Antibiotics are recommended after Genitourinary (GU) instrumentation, specifically for patients with risk factors or undergoing complex procedures.
Recommended Antibiotics
- Ciprofloxacin or trimethoprim-sulfamethoxazole are commonly used for prophylaxis in patients receiving ureteral stents who are at high risk for infection 1
- Ceftriaxone or ampicillin/sulbactam can be used to cover expected uropathogens in high-risk patients 1
- Gentamicin has been shown to reduce the rate of post-cystourethroscopy positive urinalyses 1
Patient Risk Factors
- Immunocompromised patients
- Patients with recurrent urinary tract infections
- Patients with uncontrolled diabetes
- Patients with a history of infected renal stones
Procedure-Related Factors
- Complex surgery requiring high levels of instrumentation under general anesthesia
- Length of time the device remains in place
Duration of Prophylaxis
- Prophylaxis should begin within 60 minutes of the surgical incision and generally should be discontinued within 24 hours 1
From the Research
Recommended Antibiotics
The following antibiotics are recommended after Genitourinary (GU) instrumentation:
- Cefazolin 2
- Cefotaxime 2
- Amoxicillin 3
- Cephalexin 3
- Trimethoprim-sulfamethoxazole 4
- Gentamicin and ampicillin 5
Patient Selection for Antibiotic Prophylaxis
Antibiotic prophylaxis is recommended for patients with certain risk factors, including:
- Known relevant genitourinary anomalies 4
- Diabetics 4
- Prior genitourinary surgery 4
- History of recurrent UTI 4
- Post-menopausal women 4
- Recently hospitalized patients 4
- Patients with cardiac valvular disease 4
- Nutritional deficiencies or obesity 4
- Known relevant neurogenic lower urinary tract dysfunction 4
- Elevated PVR 4
- Asymptomatic bacteriuria 4
- Immunosuppression 4
- Age over 70 4
- Patients with any indwelling catheter, external urinary collection device, or performing intermittent catheterization 4
Administration of Antibiotic Prophylaxis
Antibiotic prophylaxis should be administered as a single dose, preferably perioperatively, and continued for no longer than 24 hours postoperatively 2. The choice of antibiotic and duration of treatment should be based on the patient's individual risk factors and medical history.