PURPOSE: We evaluated the efficacy of antibiotic prophylaxis for shock wave lithotripsy in patients with proven sterile urine before treatment.
MATERIALS AND METHODS: A systematic search of PubMed®, Embase® and the Cochrane Library was performed to identify all randomized controlled trials that compared the effects of antibiotic prophylaxis with placebo or no treatment for patients undergoing shock wave lithotripsy who had preoperative sterile urine. The outcomes included symptoms, fever, positive urine culture, urinary tract infection and risk factors. The Cochrane Collaboration Review Manager software (RevMan 5.1.4) was used for statistical analysis.
RESULTS: The study inclusion criteria were met by 9 trials (3 placebo controlled and 6 no treatment controlled) involving 1,364 patients. The synthesized data from these randomized controlled trials indicated that there were no significant differences between the prophylactic group and the control group in symptoms, rate of fever (RR 0.36, 95% CI 0.07-2.36, p = 0.31), rate of positive urine culture (RR 0.77, 95% CI 0.54-1.11, p = 0.17) and incidence of urinary tract infection (RR 0.54, 95% CI 0.29-1.01, p = 0.05). Antibiotic prophylaxis had no potentially beneficial effect on the prevention of infection in patients with a temporary ureteral catheter related to shock wave lithotripsy.
CONCLUSIONS: Prophylactic antibiotics could not improve symptoms, and decreased neither the rate of fever and positive urine culture, nor the incidence of urinary tract infection after shock wave lithotripsy. Antibiotic prophylaxis is not necessary for shock wave lithotripsy, especially when no or low risk factors are presented.
Copyright © 2012 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.
J Urol. 2012 Sep 14. pii: S0022-5347(12)04900-2. doi: 10.1016/j.juro.2012.08.215. [Epub ahead of print]
PMID: 22704118 [PubMed - in process]
The conclusion from this review of published studies comparing pre-ESWL antibiotics and no antibiotics was that routine administration of antibiotics before ESWL is not necessary. There were no differences in terms of fever, positive urine culture or urinary tract infection after the treatment. This conclusion is in line with my own personal experience during the past 25 years with administration of antibiotics only to patients with positive bacteriuria/urine culture, history of urinary tract infections, stone morphology suggesting infection stone or the presence of a percutaneous nephrostomy catheter.