Efficacy of 1 versus 3 days of intravenous amikacin as a prophylaxis for patients undergoing transurethral resection of the prostate: A prospective randomized trial

Abstract

Introduction: There are no uniform guidelines on the duration of antibiotic prophylaxis for transurethral resection of the prostate (TURP). The objective of this study was to evaluate the efficacy of 1 day versus 3 days of intravenous amikacin as prophylaxis, before TURP. Materials and Methods: In this prospective randomized control trial, patients with sterile preoperative urine culture were randomized to receive either 1 day (Group A) or 3 days (Group B) of intravenous (IV) amikacin. All patients had their catheter removed on the 3rdday and a midstream urine culture was obtained on the 4thday. The follow-up was scheduled at 1 week and at 1 month. The rate of bacteriuria on the 4thpostoperative day was analyzed as the primary outcome. The secondary outcomes included symptomatic urinary tract infection (UTI), its risk factors, and other complications at 1 month. Results: Of the 338 patients randomized, 314 patients were evaluable until day 7 and 307 until 1 month. Bacteriuria rate at day 4 (Group A: 8.8% [95% confidence interval (CI): 4.2-13.2]; Group B: 4.4% [95% CI: 1.2%-7.7%], P = 0.124, Fisher's exact test) was similar in both the groups. At 1 month, the rate of symptomatic UTI was also similar in both the groups (3.5% [95% CI: 0.8-6.9] vs. 1.7% [95% CI: 0.2-4.2], P = 0.344, Fisher's exact test). Bacteriuria (colony-forming unit, >104/ml) at day 4 was a significant risk factor for developing symptomatic UTI (P = 0.006). Antibiotic resistance was higher in Group B (P = 0.002) (Group A: 7.1% [95% CI: 6.3-20] vs. Group B: [71%, CI: 38-104], P = 0.0021, Fisher's exact test). Conclusion: One day is possibly noninferior to 3 days of IV amikacin as prophylaxis in patients undergoing TURP with respect to bacteriuria and symptomatic UTI, with an added advantage of lower antibiotic resistance.