Fosfomycin trometamol vs ciprofloxacin for antibiotic prophylaxis before transrectal ultrasonography-guided prostate biopsy: A meta-analysis of clinical studies

Objectives: To perform a systematic review and meta-analysis of clinical studies to assess the comparative prophylactic effectiveness of fosfomycin trometamol (FMT) vs ciprofloxacin (CIP) in men who underwent transrectal ultrasonography-guided prostate needle biopsy (TRUS-PNB), as infectious complications are a major concern after TRUS-PNB and although fluoroquinolones are currently the first choice, an increase in resistance has raised the question about its recommendation and FMT is a broad-spectrum oral antibiotic with low bacterial resistance. Methods: A systematic review was performed between January 1970 and June 2017 using the Web of Science, Scopus and PubMed databases to identify relevant studies. Preferred Reporting Items for Systematic Reviews and Meta-analysis criteria were used for article selection. Outcomes of interest were febrile and afebrile urinary tract infections (UTIs) and the presence of fluoroquinolone-resisitant (FQR)- or extended-spectrum β-lactamase (ESBL)-producing uropathogens in urinary cultures. Results: Four studies including 2331 men were analysed; 1088 had FMT and 1243 CIP as antibiotic prophylaxis before TRUS-PNB. FMT prophylaxis resulted in significantly less afebrile (odds ratio [OR] 0.21, 95% confidence interval [CI] 0.12–0.38; P < 0.001) and febrile (OR 0.15, 95% CI 0.07–0.31; P < 0.001) UTIs than CIP. Amongst all urine cultures, patients in the FMT arm also had a significantly lower prevalence of FQR and ESBL (E. coli or K. pneumoniae) microorganisms when compared to the CIP group (OR 0.25, 95% CI 0.12–0.21, P = 0.001; and OR 0.24, 95% CI 0.10–0.58, P = 0.001, respectively). Conclusions: Antibiotic prophylaxis with FMT before TRUS-PNB was associated with lower rates of infectious complications when compared to CIP. Abbreviations: CIP: ciprofloxacin; ESBL: extended-spectrum β-lactamase; FMT: fosfomycin trometamol; FQR: fluoroquinolone-resisitant; OR: odds ratio; PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses; TRUS-PNB: TRUS-guided prostate needle biopsy