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Antibiotic prophylaxis usually unnecessary before shock wave lithotripsy

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – Patients with sterile urine before undergoing shock wave lithotripsy can forgo antibiotic prophylaxis, according to the results of a meta-analysis reported in the August issue of the Journal of Urology online

“Prophylactic antibiotics could not improve symptoms, and decreased neither the rate of fever and positive urine culture, nor the incidence of urinary tract infection after shock wave lithotripsy,” the authors found.

Dr. Wei Qiang and colleagues at West China Hospital of Sichuan University, say the necessity of routine antibiotics to prevent infectious complications in patients undergoing shock wave lithotripsy (SWL) is widely debated. In fact, guidelines issued by the European Association of Urology and the American Urological Association are contradictory.

To look into the issue, the team identified nine randomized trials comparing antibiotic prophylaxis to placebo or no treatment in a total of 1364 SWL patients with sterile urine before treatment.

A synthesis of the data showed that outcomes were not significantly different between the prophylactic group and control group, the investigators found.

Specifically, the overall risk ratio for a positive urine culture in the two groups was 0.77, but the p value was 0.17. Similarly, there were no statistically significant differences in rates of fever (RR 0.39; p=0.31), short-term urinary tract infection (RR 0.55; p=0.06) or mid-term UTI (RR 0.49; p=0.56).

“Antibiotic prophylaxis appears to be unnecessary for SWL, especially when no or low risk factors are present,” Dr. Wei and colleagues conclude. “However, more high quality randomized controlled trials, particularly on various risk factors, are still needed to address this issue.”

SOURCE:

Antibiotic Prophylaxis for Shock Wave Lithotripsy in Patients with Sterile Urine Before Treatment May be Unnecessary: A Systematic Review and Meta-Analysis

J Urol 2012;188:441-448.