Hungarian Society of Urology

The role of fosfomycin as an antibiotic profilaxis before transrectal prostate biopsy: a systematic review

DOI: 10.22591/magyurol.2023.4.fehera.191

Fehér Ádám Miklós dr.1, Bajory Zoltán dr.1, Köves Béla dr.2
1Szegedi Tudományegyetem, Szent-Györgyi Albert Klinikai Központ,
Urológiai Klinika, Szeged (igazgató: Bajory Zoltán dr.)
2Jahn Ferenc Dél-pesti Kórház, Urológiai Osztály, Budapest (osztályvezető: Tenke Péter dr.)


Introduction: Transrectal prostate biopsy is one of the most frequently performed urological procedure. During the biopsy enteral bacteria may pass into the urinary tract or the blood stream causing infectious complications. To prevent possible infectious complications antibiotic prophylaxis must be used. Due to the increasing number of resistant bacterial strains and the potential side effects, the previously widely used fluoroquinolones are not permitted anymore in this indication. Therefore, there is a growing interest in alternative prophylactic antibiotics for prostate biopsies, with fosfomycin being a promising candidate. The aim of this systematic review is to summarize and report the available scientific evidence on the prophylactic use of fosfomycin for prostate biopsies.

Materials and methods: We systematically reviewed the PubMed and ScienceDirect databases until 25.09.2022 for studies comparing the prophylactic use of fosfomycin versus fluoroquinolones in case of prostate biopsies. Prospective randomized controlled trials were highlighted.

Results: Eleven original publications were identified from which 3 were prospective completely randomized controlled trials. According to the majority of the studies, the preventive effect of fosfomycin on postoperative infectious complications was at least as good as the fluoroquinolones. The two thirds of prospective randomized controlled trials showed better results of fosfomycin.

Conclusion: Fosfomycin could be a good alternative to fluoroquinolones as a choice for antibiotic prophylaxis during transrectal prostate biopsies.


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