Antibiotics before Biopsy

[janebob99]

Does anyone have information about the use of antibiotic prophylaxis before a transrectal biopsy? I've read that e-coli is now resistant to fluoroquinolones (e.g., Cipro).

[Tall_Allen]

If you can, find an expert at transperineal biopsy.

[janebob99 in reply to Tall_Allen]

Thanks! I have my first urologist oncologist appointment next week, and I will ask about transperineal biopsy. Do you have any recommendations if I have to go out of town? (I'm in New Mexico). I'm also considering going to Grand Junction, CO, or San Diego where they use the new MicroUltrasound (29 MHZ) machine for doing MRI/US fusion guided biopsies.

[Tall_Allen in reply to janebob99]

Dr. Edward Uchio at UC Irvine

[janebob99 in reply to Tall_Allen]

Thanks !!

[pd63]

Avoid transrectal if at all possible, I've had no issues with 2 transpireneal with local anaesthetic without problems.The procedure was uncomfortable but not too painful.

[janebob99 in reply to pd63]

Thanks. I agree.

[CancerConcierge]

Mayo, in Phoenix …

[janebob99 in reply to CancerConcierge]

Unfortunately, they don't take my insurance and they won't allow me to self-pay.

[Mgtd in reply to janebob99]

Interesting comment about healthcare insurance at Mayo. Not sure why but my buddy was told they only take original Medicare not the private kind. Apparently they went that way some time ago.

[janebob99 in reply to Mgtd]

I have UnitedHealthCare Medicare Advantage and Mayo doesn't take that. They do take straight Medicare, though.

[CancerConcierge in reply to janebob99]

They don’t take Medicare Advantage plans… it’s too bad they won’t allow self pay.

[Jancapper]

I had the traditional trans rectal 12 core biopsy. If I remember correctly, two double strength prophylactic Septra were prescribed. I think I took one pill the night prior and the second the morning of. No problems and in and out in less than 30 minutes. Super easy.

[Photographerhere]

i was put on an antibiotic a day before and two days following.

[Mgtd in reply to Photographerhere]

Same here. I found that doing the fiducial markers with the Gel was more painful then the biopsy.

[janebob99 in reply to Mgtd]

Thanks for the warning!

[maley2711]

I found some favorable studies re the use of the topical Povidine.....here is one....

pubmed.ncbi.nlm.nih.gov/360...

I don't know if they also used an oral antibiotic. I requested Povidine and the urologist agreed......did she actually use it, I have no idea...I was sedated!! I ended up with a catheter as my adverse event. I was told this is rare complication ???

[janebob99 in reply to maley2711]

I wonder why you needed a catheter. Perhaps a needle hit the urethra? Thanks for the paper. It showed a 50% reduction in infection rates by using Povidine-Iodine wash. Here's a similar paper on 3 different methods of rectal cleansing using Povidine-Iodine that shows one technique is much better than the other two:

pubmed.ncbi.nlm.nih.gov/308...

[dentaltwin in reply to maley2711]

I only read the abstract. But those infection rates--3.9% vs. 6.4% in the control group--no mention of antibiotic px, and those infection rates are pretty scary-high! Kinda makes the case for trans perineal bx.

[janebob99 in reply to dentaltwin]

Absolutely ! But, if you do antibiotics 3-5 days before (not Cipro, because the eColi is resistant to flouroquinolones like Cipro), and do a povodine-iodine rectal scrub, then the infection rates go way down I believe.

[dentaltwin in reply to janebob99]

I don't know what the docs are using these days--I was given Cipro, but only the day before and I think 2 days after. Can't see why you'd need any antibiotic for 3-5 days before--the intent is prophylaxis, not treating an infection.

Transperineal makes this all moot, and frankly I don't understand that not being the standard of care. My brother, who was just diagnosed this year, had transperineal, but he had to ask for it, and needed to wait longer for it to be done than would have been the case for a TRUS biopsy.

[cpl901]

I had a transrectal with antibiotics to take just for the day. It was just preventive. Transrectal is may be more risky than transperineal. Every biopsy has an infection risk. I ve read that transrectal infection risk is about 1/100, but i dont know how severe the infection could be.

[janebob99 in reply to cpl901]

Thanks ! If you're the one who ends up with sepsis it can put you in the hospital. I read that you should take the antibiotic 3-5 days before the procedure, and use something like keflex which e-coli is not resistant to, plus use povidine-iodine scrub of the rectum with soaked cotton balls.

[janebob99 in reply to cpl901]

I also plan on getting a last test where they take a rectal swab and culture the bacteria to see if I have antibiotic-resistant e-coli strains.

[janebob99 in reply to janebob99]

Should be "lab test", not "last test"!

[bubularich]

I had trans rectal biopsy with full sedation 6 months ago. When I inquired about antibiotics they told me that they're given intravenously with the sedation so none were required before or after. I had no complications but after reading this forum, I will definitely request transperineal next time.

[BanjoPicker]

I had a transrectal biopsy before I found this site. Ignorance is bliss. Took the antibiotics, had the procedure, and had no problems.

[Currumpaw]

I had several transrectal biopsies, saturation type. The urologist used a combination of six 500 mg Cipro pills, two the day before the biopsy, two the day of the biopsy and two the day after the biopsies. Just before the biopsies were begun, I was also given what the nurse termed, a humongous, intramuscular shot of Levaquin. I had old, long forgotten, athletic injuries to both shoulders and a sciatic ligament. These injuries all returned worse than the original injuries were thirty and twenty years prior. A chiropractor that had begun her practice when the fluoroquinolones came out told me that the warning for side effects is for the Achilles tendon but that over the decades, her experience with thousands of patients has been that the fluoroquinolones go for old injuries first. Two shoulders, one shoulder worse than the other and a back so bad that I couldn't bend over long enough to scoop the cat's litter box? For someone that was about to open a one-on-one personal training business and whose workout had included deadlifts with 400 lbs. I had four, one-hundred-pound plates among the nearly $30,000 of equipment I had bought. For years I rarely slept for more than an hour before pain awakened me and I had to shift my sleeping position because of the fluoroquinolone damage. I am better now but will never be able to do what I had hoped to do. I have given up hope that the damage will ever heal so that I can be somewhat --normal. I will always need to be careful of my shoulders and my back will always have pain.

Fluoroquinolones have harmed many. Those who have had the fluoroquinolones have twice the incidence of aortic aneurysms. Read about the fluoroquinolones and their dangers.

I have been selling that equipment. I should have sold it during the pandemic. I feel that combining the fluoroquinolones was a serious mistake which unfortunately destroyed the life I had.

Those who have advised a trans perineal biopsy are right. A trans perineal done real time, in bore using a mp 3.0T MRI is best. The trans perineal also can access areas of the prostate that the transrectal cannot access. Rocephin and Cefdinir are two drugs that can be used rather than a fluoroquinolone if needed.

Currumpaw

[janebob99 in reply to Currumpaw]

Thank you for your detailed reply. That's a bummer about your joint pain. I have had chronic low back pain for decades and I take 75 mg of morhine every day to manage it.

I didn't know about the cardiovascular problems with fluoroquinolone. I did read that e-Coli are now very resistant to fluoroquinolone. I plan on getting a test where they culture a rectum swab to look for e-Coli resistance .

I'm not sure I can get a transperineal biopsy in Albuquerque. I know that UCLA does TP biopsies inside of an MRI machine, but it's a pain to travel there. Thanks for the tip on Rocephin and Cefdinir! I'll look them up.