Ciprofloxacin infusion versus third generation cephalosporin as a surgical prophylaxis for percutaneous nephrolithotomy: a randomized study

INTRODUCTION: Percutaneous nephrolithotomy (PCNL) is considered a clean-contaminated surgical procedure. The American Urological Association has recommended different preoperative antimicrobial prophylaxis for various urological procedures to prevent surgical site infections, postoperative fever, and possible sepsis. The European Association of Urology (EAU) antibiotic guidelines endorse giving either a second or third-generation cephalosporin, trimethoprim-sulfamethoxazole, fluoroquinolone or aminopenicillin with a β-lactamase inhibitor. The aim of the present study is to prospectively compare two different protocols of antibiotic prophylaxis in PCNL. MATERIAL AND METHODS: Successfully consented patients with sterile urine preoperatively who were awaiting percutaneous nephrolithotomy were randomized into two groups. The first group (n = 41) was given a single dose of 200 mg ciprofloxacin infusion, while group two (n = 43) was given 2 mg of cefotaxime divided into 2 doses; during induction of anesthesia and 12 hours later. The occurrence of perioperative infection-related events would be compared in both groups. RESULTS: Both groups had similar age, sex, Body Mass Index, and stone composition. No statistical difference was found regarding stone size, stone culture, irrigation fluid volume, operative time and urine pelvis culture result in both groups (Table 2). Two patients (5%) developed postoperative fever in the 1(st) group compared to 12 patients (28%) in the second group (p = 0.02). CONCLUSIONS: A prophylactic regimen consisting of a single dose ciprofloxacin infusion during induction of surgery showed a higher efficacy as a preoperative antibacterial preparation, compared to cefotaxime, in protection against postoperative fever in patients undergoing PCNL.