AUA revises statement on antibiotic prophylaxis for prostate Bx

The AUA has revised its best practice statement on antibiotic prophylaxis for transrectal prostate biopsy to incorporate recent Centers for Medicare & Medicaid Services approval of intramuscular administration of antimicrobials.

Before Jan. 1, unless the urologist wanted to use an oral fluoroquinolone, the only optional route was intravenous administration.

The recommended IM and IV antibiotics for transrectal prostate biopsies now include quinolones, first-, second-, and third-generation cephalosporins, an aminoglycoside plus metronidazole or clindamycin, and aztreonam (Azactam) plus metronidazole or clindamycin. Only fluoroquinolones can be given orally for routine prophylaxis for transrectal prostate biopsies.

The AUA said cephalosporins or aminoglycosides are a better choice for antimicrobial prophylaxis for transrectal prostate biopsy in some communities owing to a high rate of bacterial resistance to fluoroquinolones. The AUA lobbied the Surgical Care Improvement Project, which informs CMS, for approving the IM route of administration in order to simplify the peri-procedural process for transrectal prostate biopsies for urologists and their patients, said J. Stuart Wolf, MD, chair of the AUA panel that developed the best practice statement.

IM administration has always been possible, but only after approval of this route by CMS for transrectal prostate biopsy can IM administration be used and the urologist remain in compliance. The issue is not reimbursement, but whether CMS approves it as fulfilling outpatient process quality measures for transrectal prostate biopsies, said Dr. Wolf, of the University of Michigan, Ann Arbor.

There have been several recent studies on the topic. One study showed targeted antimicrobial prophylaxis based on microbiologic findings from rectal swab cultures significantly reduces the incidence of post-transrectal ultrasound-guided prostate biopsy (TRUSP) infectious complications and has the potential to decrease the overall cost of care. Results of another study documenting a significant risk of fluoroquinolone-resistant Escherichia coli infections after TRUSP prompted a change in the antibiotic prophylaxis protocol for men undergoing this diagnostic procedure at one large institution.

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