Approach to Antimicrobial Prophylaxis for Urology Procedures in the Era of Increasing Fluoroquinolone Resistance

Abstract

Objective: To evaluate rationale antimicrobial prophylaxis options in patients undergoing urologic procedures in the era of increasing fluoroquinolone resistance. Data Sources: Literature was accessed through MEDLINE (1980-October 2013) using the search terms “urologic surgical procedures,” “antibiotic prophylaxis,” and “drug resistance.” Study Selection and Data Extraction: Pertinent article titles and abstracts were reviewed by the authors in addition to reference citations from publications. All English language publications identified were evaluated. Data Synthesis: The American Urology Association guidelines recommend fluoroquinolones (FQs) as first-line agents for preoperative prophylaxis to prevent infection after urologic procedures. Since the latest publication of these guidelines in 2008, resistance within this class of drugs has been increasing especially among common urologic pathogens like Escherichia coli. Limited data are available to support non-FQ alternatives for preoperative prophylaxis, and small studies published prior to 2000 have been conducted using such regimens with success. FQs have become the mainstay of prophylaxis in this population because of ease of administration, relatively low cost, and excellent oral bioavailability; however, β-lactam class antimicrobials may be emerging as effective alternatives based on more favorable resistance profiles. Conclusions: Based on the current available literature, geographic areas with increasing FQ resistance should consider using cephalosporin agents as alternatives for prophylaxis in patients undergoing urologic procedures, reserving FQ in patients unable to tolerate β-lactams because of type-1 hypersensitivity reactions or other adverse effects.