Search

The influence of short-term prophylactic courses of cefotaxime on the microbial environment was studied. The distribution of bacterial species and their antibiotic resistance was recorded in isolates collected over a six-year period, during which time cefotaxime was used for perioperative prophylaxis in patients undergoing transurethral prostatic resection. In three consecutive studies covering the six-year observation period, the species distribution and antibiotic resistance patterns remained essentially unchanged for both cefotaxime and ampicillin. Examination of the faecal coliform flora in 23 patients given cefotaxime revealed no marked qualitative or quantitative change in the flora. It is concluded that short-term prophylactic courses of cefotaxime do not promote the emergence of resistance in the aerobic bacterial flora.

In a prospective randomized study of 96 patients, the effect of a short antibiotic course given after transurethral prostatic resection was analysed. Cefotaxime (1 g. i.m. every 12 hours to a total of 3 g) was given to 47 patients with the first doses when the postoperative catheter was removed while 49 were assigned to a control group without antibiotic. The frequency of bacteriuria was 48% preoperatively in the cefotaxime group and 33% six weeks postoperatively. In the control group the corresponding figures were 63% and 50% (p greater than 0.1). There were two cases of septicemia in each group immediately post-operatively whereas upper urinary tract infection developed in five patients in the control group and one patient in the cefotaxime group (p greater than 0.1). The total number of infectious and non-infectious complications was significantly greater in the control group (22) compared to the cefotaxime group (12) (p less than 0.05). The patients receiving the antibiotic remained a shorter time in hospital as compared to the controls. Bacteriological analysis showed a good in vitro effect of cefotaxime on isolated bacteria.

This study was undertaken to analyse the results in 192 patients who 3 to 4 years earlier had undergone transurethral resection (TUR) in a controlled clinical trial on the value of a short peri-operative course of antibiotics. The survival rate was comparable in both groups. Most deaths were due to cardiovascular disease and/or cancer of the prostate and the gastrointestinal tract. Infectious events predominated in the control group and more antibiotics were prescribed for these patients during follow-up than for the patients in the peri-operative antibiotic group. Bacteriuria was found in 24% of patients, evenly distributed between the groups. Eighty-three per cent were satisfied with the results of prostatectomy but 38% complained of symptoms from the lower urinary tract. The maximum urinary flow rate was not influenced by the presence of bacteriuria and/or symptoms. There was no difference between the groups regarding mortality or morbidity except for the frequency of post-operative urethral stricture formation, which was significantly higher in the controls. It was concluded that prospective long-term follow-up is indicated to assess the effect of short peri-operative antibiotic courses.

In a prospective randomized study of 192 patients, the effect of a short course of cefotaxime in connection with transurethral prostatic resection was analyzed. The antibiotic was given to 98 patients, while 94 were assigned to a control group without antibiotic. The frequency of bacteriuria in the cefotaxime group was 43% preoperatively and 18% six weeks postoperatively. In the control group the corresponding figures were 40 and 42% (p less than 0.01). Complicated postoperative infection did not occur in the cefotaxime group, but in the control group there was one case of septicemia and seven patients had upper urinary tract infections (p less than 0.01). In the cefotaxime group, patients with preoperatively negative urine culture were prevented from acquiring bacteriuria, and 67% of preoperatively present infections were eliminated at six weeks after the operation, as compared with 30% in the control group. There were essentially no side effects of cefotaxime. Renal function was not influenced by the combination of cefotaxime and furosemide.

The identity and antibiotic sensitivity of the isolated bacteria from 179 patients undergoing transurethral resection of the prostate were analysed. The patients were randomized into a group receiving a short course of cefotaxime in conjunction with the operation and a control group given no antibiotics. Preoperatively 70 patients had bacteriuria (greater than or equal to 10(7) CFU/l) with a predominance of Gram-negative bacteria (57 isolates, mainly Escherichia coli, Enterobacter, Klebsiella ssp, Proteus ssp), although Gram-positive species (24 isolates, mainly enterococci and Staphylococcus epidermidis) were also frequently encountered. Preoperatively isolated pathogens were evenly distributed in both groups and the sensitivity pattern was comparable. In the cefotaxime group postoperative recurrence of the preoperatively identified bacteria occurred in a lower frequency (11/43) than persistence in the control group (24/38). Only Gram-negative pathogens were isolated from patients with postoperative septicemia and upper urinary tract infections indicating that it is most important to direct prophylaxis against Gram-negative bacteria. A high degree of sensitivity against cefotaxime, gentamicin, trimethoprim, co-trimazine and a combination of ampicillin and mecillinam was recorded among both pre- and postoperatively isolated bacteria.