"Even though TRUSP Bx is a common urological procedure there are currently no national guidelines regarding antibiotic prophylaxis and local protocols vary widely across the UK" says Professor Neal. "However, the importance of using prophylaxis for a biopsy, to reduce the occurrence of infective complications following surgery, has been well documented.

"This is the first study to compare the use of co-amoxiclav and gentamicin with the use of ciprofloxacin for TRUSP Bx. Patients given the original ciprofloxacin regime experienced significantly fewer infective complications than those on the new regime and this audit study supports the use of locally determined prophylactic regimes for this procedure."

The authors stress that antibiotic prophylaxis needs to reflect the local situation, both in terms of tissue penetration, the organisms encountered and their susceptibilities and the local C. difficile rates. They add that any changes also need to be subject to frequent review.

"Any alteration to existing departmental antibiotic policies should be linked to strong clinical evidence, because such changes may potentially result in significant ill health and potential harm, as well as the financial burden of treating new complications" concludes Professor Neal.

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