Review of antibiotic prophylaxis recommendations for office-based urologic procedures.

Prophylactic antibiotic recommendations for urologic procedures are not well established. Any assessment of the need for antibiotics entails thorough cost-benefit analysis. The subject of this article is an evaluation of the role of antimicrobial prophylaxis for outpatient office-based diagnostic procedures, including diagnostic flexible cystoscopy, transrectal ultrasound biopsy, and urodynamics. Relevant studies were identified using MEDLINE database searches and review of selected bibliographies. Studies of infections after transrectal ultrasound and biopsy suggest that periprocedure antibiotics are indicated, but that the exact course and timing have not been defined. Most evidence suggests that outpatient cystoscopy is associated with minimal infectious risk and that the routine administration of oral antibiotics is not indicated. Support in the literature for the use of prophylactic antibiotics at the time of urodynamic evaluation is equivocal. The current prophylactic regimens at the University of Michigan are presented as recommendations, but optimization of antimicrobial prophylaxis will require multicenter studies with large numbers of patients.