Wagenlehner FM, Thomas PM, Naber KG
Klinik und Poliklinik für Urologie, Kinderurologie und Andrologie, Universitätsklinikum Giessen und Marburg - Standort Giessen, Giessen, Germany

Abstract

INTRODUCTION: Increasing antibiotic resistance also has an impact on perioperative antibiotic prophylaxis (PAP). This narrative review evaluates fosfomycin trometamol (FT) as PAP in endourological interventions.

MATERIALS AND METHODS: Nine clinical studies including 4 randomized comparative studies were analyzed. A total of 1,614 patients received FT as PAP for different endourological procedures and extracorporeal shock wave lithotripsy [ESWL; i.e. cystoscopy (n = 498), urodynamic studies (n = 39), ureteropyeloscopy (n = 10), urethrotomy (n = 20), lithotripsy (n = 15), transurethral resection of bladder tumors (n = 139), transurethral resection of the prostate (n = 843), ESWL (n = 20), ureterorenoendoscopic lithotripsy (n = 18), percutaneous nephrostomic lithotripsy (n = 12)].

RESULTS: In 8 clinical studies, FT was shown to be effective in preventing healthcare-associated urinary tract infections (HAUTIs). One study showed no benefit. The usual dosage regimen was oral administration of 3 g of FT 3 h before and 24 h after the procedure. In 1 randomized comparative study investigating HAUTIs after diagnostic cystoscopy, it could also be shown that a single oral dose of 3 g of FT 3 h before cystoscopy was as effective as a double dose.

CONCLUSION: According to the published results, for traumatic endourological interventions and surgical procedures, an oral dosage of 3 g of FT 3 h before and 24 h after the procedure and only 1 (prior) oral dosage for diagnostic procedures might be an alternative if PAP is indicated. Limitations of the studies are the low numbers of patients included for most indications.

Urol Int. 2014;92(2):125-30. doi: 10.1159/000355103. Epub 2013 Sep 13.
PMID:24051657[PubMed - in process]