Detecting excessive antibiotic use in urology – less is more
Antibiotics are frequently used in urology. However, using them less would reduce the development of antibiotic resistance. We are therefore comparing a single prophylactic dose of antibiotics following urological surgery with the current clinical practice of three days or more.
Project description (ongoing research project)
We are conducting a questionnaire-based pilot study of real-life prophylactic use of antibiotics in two common prostate operations. Around a quarter of urologists comply with European guidelines for transurethral resection (trimming away diseased tissue) and GreenLight Laser PVP (vaporisation of diseased tissue). We will then divide patients into two groups as part of a randomised prospective study. The first group will receive a single prophylactic dose as prescribed by the guidelines, whereas the second will receive a three-day prophylactic course of the type that is very commonly used in practice. This will enable us to compare the effect of each type of prophylaxis on postoperative infection, antibiotic-associated side effects and the development of antimicrobial resistance.
Due to the hugely widespread use of antibiotics, antibiotic-resistant germs occur more frequently in urology units than in other disciplines. Around ten thousand men undergo transurethral resection in Switzerland every year, while laser vaporisation has become established as an alternative treatment for patients undergoing anticoagulation therapy. The large number of interventions also explains the suspected impact on resistance development if prophylaxis is “extended”.
Our aim is to demonstrate not only that antibiotic use can be substantially reduced in the urological operations in question without jeopardising patient safety, but that doing so will reduce the development of antimicrobial resistance.
If antibiotic prophylaxis is reduced to a single dose instead of several doses over a period of three days, it will not only reduce the development of antimicrobial resistance, but also expose patients to fewer side effects. This improvement, which is comparatively simple to implement, would benefit a large number of patients and help to ensure that tried-and-tested antibiotics continue to be used in prophylaxis and treatment.
Single-Dose Versus 3-Day Cotrimoxazole Prophylaxis in Transurethral Resection or Greenlight Laser Vaporisation of the Prostate: A Pragmatic, Multicentre Randomised Placebo Controlled Non-Inferiority Trial