Fax +41 61 306 12 34 E-Mail karger@karger.ch www.karger.com Original Paper Urol Int 2012;89:439–444 DOI: 10.1159/000342370 The Effectiveness of Single-Dose Fosfomycin as Antimicrobial Prophylaxis for Patients Undergoing Transrectal Ultrasound-Guided Biopsy of the Prostate Şakir Ongün a Güven Aslan a Vildan Avkan-Oguz b Departments of a Urology and b Infectious Diseases and Clinical Microbiology, Dokuz Eylul University School of Medicine, Izmir , Turkey tant infections, and all of them occurred after the ciprofloxa- cin or levofloxacin prophylaxis and none after fosfomycin prophylaxis. Conclusions: The ease of use of fosfomycin, re- ducing the rate of fluoroquinolone-resistant infections and hospitalizations shows that it would be an alternative and effective drug for antimicrobial prophylaxis in TRUSBP. Copyright © 2012 S. Karger AG, Basel Introduction Transrectal ultrasound-guided biopsy of the prostate (TRUSBP) is generally accepted as the standard proce- dure to detect prostate cancer. Although it is a safe pro- cedure with low morbidity, it carries the risk of serious and potentially life-threatening infections. Urinary tract infection (UTI) is considered the second most frequently noted complication of prostate biopsy, after bleeding complications. It has been described as a minor or major complication, depending on its severity. Although noncomplicated or afebrile UTIs frequently occur after biopsy (1.2–11.3%), complicated or febrile UTIs are also not uncommon (1.4–4.5%) [1, 2]. When fe- brile UTI does occur, it is typically serious and leads to hospitalization. Key Words Fluoroquinolone  Fosfomycin  Prophylaxis  Prostate biopsy  Transrectal ultrasonography  Urinary tract infection Abstract Objectives: It was the aim of this study to evaluate the effi- cacy of single-dose fosfomycin prophylaxis as an alternative to fluoroquinolone-based prophylaxis in transrectal ultra- sound-guided biopsy of the prostate (TRUSBP). Methods: We evaluated the records of 620 patients who had under- gone TRUSBP from January 2010 to July 2011. Patients re- ceived a single dose of 3 g oral fosfomycin or a single dose of 500 mg oral levofloxacin or 500 mg oral ciprofloxacin twice daily administered for 5 days starting 1 day before the prophylaxis procedure. We reviewed all febrile and afebrile urinary tract infections (UTIs) within 1 month after TRUSBP. Results: Of the 620 patients, 19 (3.0%) developed febrile UTI and 51 (8.2%) developed afebrile UTI after biopsy. Of the 19 patients with febrile UTI, 1/19 (5.2%) received fosfomycin, 4/19 (21%) received levofloxacin and 14/19 (73.6%) received ciprofloxacin for prophylaxis. Of the 51 patients with afebrile UTI, 4/51 (7.8%) received fosfomycin, 8/51 (15.6%) received levofloxacin and 39/51 (76.4%) received ciprofloxacin for prophylaxis. There were a total of 10 fluoroquinolone-resis- Received: May 14, 2012 Accepted after revision: July 27, 2012 Published online: September 22, 2012 Internationalis Urologia Dr. Şakir Ongün Dokuz Eylul University School of Medicine Department of Urology Izmir (Turkey) E-Mail sakirongun  @  hotmail.com © 2012 S. Karger AG, Basel 0042–1138/12/0894–0439$38.00/0 Accessible online at: www.karger.com/uin