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Urinary tract infection prophylaxis in transurethral surgery: Oral lomefloxacin versus parenteral cefuroxime
Urinary Tract Infection Prophylaxis in Transurethral Surgery: Oral Lomefloxacin Versus Parenteral Cefuroxime MICHEL
CHARTON,
M.D., ANNICK
MOMBET,
M.D.,
BERNARO
GAITEGNO,
The purpose of this study was to compare the efficacy and safety of single-dose oral lomefloxacin and single-dose parenteral cefuroxime for the prevention of urinary tract infection following transurethral surgery. A total of 63 patients were enrolled in this prospective, randomized open-label study, which was conducted at two medical centers in France. Patients were randomized to receive either 400 mg of oral lomefloxacin 2-6 hours before surgery or 1.5 g parenteral cefuroxime 30-90 minutes before surgery. Postoperative clinical evaluation was performed daily, and bacteriologic evaluation included urine cultures performed 24 hours after surgery, just before and 1 day after removal of the indwelling catheter, and 3-5 days after surgery. Another urine culture was optionally performed l-3 months after surgery. Infection was defined as a urinary bacteria count ~10’ colony-forming units (CFU)/mL of urine. Of the 63 patients enrolled, 54 were evaluable for efficacy, 27 in each group. The success rate of prophylaxis was 88.9% in the lomefloxacin group and 88.5% in the cefuroxime group (p = nonsignificant). None of the 16 lomefloxacin-treated patients who were re-cultured at l-3 months was found to be infected. Adverse events were minor in both groups. A single oral dose of lomefloxacin was as efficacious and as safe as a single intravenous dose of cefuroxime for prevention of postoperative urinary tract infection in patients undergoing transurethral surgery.
From Centre Medico-Chirurgical Tenon (B.G.), Paris, France.
de la Porte de Choisy (M.C.A.M.) and Hdpital
Requests for reprints should be addressed to Michel Charton, M.D., C.M.C. de la Porte de Choisy, 6, place de Port au Prince, 75013 Paris, France.
4A-116s
April 6, 1992
The American Journal of Medicine
M.D.,
mis,
France
omefloxacin is a difluoroquinolone with an L elimination half-life of about8 hours. The prostate tissue:plasma concentration ratio for lomefloxacin 3.5 hours after oral administration was 2.0 [ll. A total of 70%of the ingesteddoseis eliminated in the urine in the first 24 hours, with high urine levels of active drug [2]. The concentrations of lomefloxacin in the prostatic tissue (and obviously in urine) are high enoughto eradicatethe majority of bacteriathat commonlycauseurinary tract infection following transurethral surgery. Lomefloxacin is efficaciousagainst gram-negativebacilli, including Enterobacteriaceae and Pseudomonas and against gram-positive cocci including staphylococci 131. Several studies [4-61 have demonstrated that, evenin patients with sterile urine, bacterial colonization of urethral mucosaand prostatic tissue exists. This fact probably explainsthe high incidence (about 35%) of urinary tract infection following transurethral surgery performedwithout antibiotic prophylaxis, as shown in the control groups of many studies comparing efficacy of a drug versus placeboin these surgical conditions [7-101. Many antibiotics of different classeshave been shown to prevent urinary tract infections occurring after transurethral prostate surgery [7-111 and transurethral bladder tumor ablation [4]. The pharmacokinetic properties of lomefloxacin andthe successof other fluoroquinolonederivatives as prophylactic agents in transurethral prostatectomy [11,12]led us to conducta randomizedstudy comparing the efficacy and safety of oral singledoselomefloxacinandintravenoussingle-dosecefuroxime to prevent urinary tract infection in patients with sterile urine undergoing transurethral surgery. PATIENTSAND METHODS A total of 63 adult (>18 years old) patients who were scheduledto undergo transurethral surgery were enrolled at two centers. The study was approved by the local ethics committee, and all patients provided written informed consent.Patients were required to have sterile urine within 48 hours before surgery. Women at risk of pregnancywere
Volume 92 (suppl 4A)
SYMPOSlUh!ON ONCE-A-DAYQUINOLONE/ CHARTONET AL
required to have a pregnancy test. Patients were excluded if they were pregnant, had a terminal illness, a history of convulsive disorders, valvular heart disease, serum creatinine >200 ,umol/L, liver function tests >.2 times the normal range, or a history of sensitivity to quinolones or cephalosporins. Patients were not enrolled if they had received any antimicrobial therapy within 2 weeks of study entry. Pretreatment evaluation, performed within 48 hours before surgery, included medical history and baseline physical examination, urine culture, and baseline clinical laboratory tests (within 48 hours prior to transurethral surgery). Patients were randomly assigned to groups receiving either 400 mg (two 200 mg capsules) of lomefloxacin orally 2-6 hours before transurethral surgery or 1.5 g of cefuroxime intravenously 30-90 minutes before the surgical procedure. The transurethral operations were done under strict surgical asepsis by means of cystoscope connected to a video camera device in an operating room. The perioperative irrigation solution was sterile 1.5% glycine in water. Postoperative drainage was ensured by a double-lumen catheter with continuous irrigation of sterile 0.9% saline solution in water. The urine was collected in a closed bag with an anti-reflux valve. Postoperatively, daily clinical examination was performed during the study, and all patients were clinically monitored and instructed to notify the investigator of any adverse event. Clinical laboratory tests were performed 3-5 days after transurethral surgery and compared to preoperative values. Urine cultures were obtained 24 hours after surgery, before the urinary catheter ablation, 1 day after the urinary catheter ablation, and 3-5 days after surgery. Another urine culture was optionally performed l-3 months after surgery. A positive urine culture was defined as a bacterial count >105 colony-forming units (CFU)/mL of urine. Blood cultures were performed if a patient had chills or temperature >38”C. The results of the two groups were compared by means of the chi-square test or Fisher’s t-test. The quantitative parameters were defined by the mean value and the standard deviation, and they were compared by Student’s t-test.
RESULTS Of the 63 patients enrolled, 32 were randomized to receive lomefloxacin and 31 to receive cefuroxime. There were no statistically significant differences in evaluable patient demographics (Table I) or in the types of surgical procedures (Table II). A total of 54 patients (2’7 in the lomefloxacin group
TABLE I Patient Demographics (Evaluable Patients)
Male/female Mean 1 Duration ageof(years1 urinary catheter (days)
Lomefloxacin ~ (n=27)
Cefuroxime ___ (n = 27)
p Value
67.67 25/2 t 9.0
68.67 26/l + 7.08
Iii
2.14 5 0.56
2.18 + 0.73
NS
NS = not srgndicant.
TABLE II Surgical Procedures (Evaluable Patients) Lomofloxacin Procedure
Cefuroxime
(n=27)
TUR prostate TUR bladder TUR prostate t bladder Ureteroscopy
(n=n)
:o’
17 8
i
1
p = not significant; TUR = transurethral resectlon.
TABLE Ill Reasons for Nonevaluability Lomefloxacin
Cefuroxime
(n = 32)
- (n = 31)
3
Postoperative indwellingcatheter >4 days Protocol violation Inclusion criteria not met Lost to followup
t, A
Total not evaluable Total evaluable
1
:
2:
2;
TABLE IV Bacteriologic Results Postoperative Preoperative
24 hours
Day l-Day
3
Lomefloxacin (n = 27) Not evaluable Infected Not infected
27(100%) 24(96%)
Cefuroxime (n = 27) Not evaluable Infected Not infected
27(100%) 26 (100%) 24 (92.3%)
Day 3-Day 5
2 i
i
1(4%1
A
;
25(100%) : (7.7%)
i (11.1%)
24(88.9%) &1.5%,
23(88.5%)
and 2’7 in the cefuroxime group) met the criteria for efficacy evaluation. Five patients in the lomefloxacin group and four, in the cefuroxime group were excluded from evaluation (Tables III and IV). The most frequent reason for exclusion was the use of an indwelling urinary catheter for >4 days. A total of 24 patients in the lomefloxacin group (88.9%) and 23 in the cefuroxime group (88.5%) had
April 6, 1992
The American Journal of Medicine
Volume 92 (suppl 4A)
4A-119s
SYMPOSIUM
ON 0NCE.A.DAY
QUINOLONE
/ CHARTON
ET AL
sterile urine throughout the study period (p = nonsignificant) (Table IV). There were six bacteriologic failures during the evaluation period, three in each group. Bacteriologic failures in the lomefloxacin group were attributed to coagulase-negative staphylococci, including Staphylococcus epidermidis (two patients), and Streptococcus agalactiae (one patient); failures in the cefuroxime group were attributed to Enterococcus sp. (one patient), Enterococcus faecalis (one patient), and Klebsiella pneumoniae plus Enterobacter cloacae (one patient). All the gram-positive cocci in the lomefloxacin group were resistant to lomefloxacin, and the E. faecalis in the cefuroxime group was resistant to cefuroxime, whereas the K. pneumoniae and E. cloacae in the cefuroxime group were moderately susceptible to cefuroxime. In the lomefloxacin group, one patient had a positive blood culture 24 hours after surgery (coagulase-negative staphylococci) and two patients had positive urine cultures (one with S. agalactiae and one with S. epidermidis) at the 3-5 day evaluation. One lomefloxacin patient had clinical signs of severe urinary tract infection (chills and fever of 39°C 1 day post-surgery). In the cefuroxime group, one patient was infected with E. cloacae and K. pneumoniae at days l-3 and days 3-5, one with Euterococcus sp. at days 1-3, and one with E. faecalis at days 3-5). There was one adverse event in each group: one patient in the cefuroxime group had pain at the site of the intravenous injection, and one patient in the lomefloxacin group complained of headache, but this was not considered by the investigator to be related to the study drug. There were no abnormal laboratory test values related to the prophylactic drugs. Follow-up was done at 4 weeks to 3 months for 33 patients, 16 in the lomefloxacin group and 1’7 in the cefuroxime group. Two patients in the cefuroxime
4A-120s
April 6, 1992
The American Journal of Medicine
group had urinary tract infections, one with Staphylococcus aureus, one with Escherichia coli. There was no infection in the lomefloxacin group.
CONCLUSION Lomefloxacin was as effective and well tolerated as cefuroxime when used as a prophylactic agent before transurethral surgery; however, lomefloxacin has an advantage in being administered orally, rather than via the usual parenteral route. Thus, lomefloxacin could be advantageously used in this indication.
REFERENCES 1. Kkmberg IW, Chrlds SJ, Madore RI, Kkmberg SR. A multicenter comparison of oral lomefloxacin versus parenteral cefotaxime as prophylacttc agents rn transurethral surgery. Am J Med 1992; 92 (Suppl 4A): 121-25. 2 Mornson PJ, Mant TGK, Norman GT, Robinson J, Kunka RL. Pharmacokrnebcs and tolerance of lomefloxacin after sequentrally Increasing oral doses. Antimicrob Agents Chemother 1989; 32: 1503-7. 3. Hirose T, Okezaki E, Kato H, Ito Y, lnoue M, Mitsuhashr S. In vitro and in vrvo activity of NY-198, a new drfluorinated quinolone. J Antimrcrob Chemother 1987: 31: 854-9. 4. Goldwasser B. Bogokowskr B, Native 0, Side AA, Jonas P, Many M. Urinary rnfections followrng transurethral resection of bladder tumors: rate and source. J Urol 1983; 129: 1123-4. 5. Gorelick JI, Senterfit LB, Vaughn ED Jr. Quantrtative bacterial tissue cuitures from 209 prostatectomy specimens: findrngs and Implications. J Urol 1988; 1: 57-60. 6. Robinson MRG, Arudpragasam ST, Saghal SM, Cross R, Fittal B, Sibbald R. Bactenuria resulting from prostahc surgery: the source of bacteria. Br J Ural 1982; 54: 542-6. 7. Botto Ii, Rrchard F, Mathieu F, Perreau AM, Camey M. Short- term prophylaxis with cefotaxime in prostatic surgery. J Antrmicrob Chermother 1984; 14 (Suppt 6): 231-5. 8. Charton M, Dosne B, Escovar P, Kopf A, Brisset JM. Trartement prophylactique minute des infections urinarres apres resection endoscopique de la prostate. Presse Med 1984; 13: 545-8. 9. Charton M, Vallanccen G, Veillon B, Bnsset JM. Anbbiotic prophylaxes of urinary tract infection after transurethral resection of the prostate: a randomrzed study. J Urol 1987; 138: 87-9. 10. Grabe M. Anhmicrobral agents in transurethral prostabc resectron. J Urol 1987; 138: 245-52. 11. Murdoch DA, Badenoch DF, Gatchalian ER. Oral ciprofloxacrn as prophylaxes rn transurethral resectron of the prostate. Br J Urol 1987; 60: 153-6. 12. Char-ton M, Mombet A, Prapotnich D. Ideal durabon of pefloxacin prophylaxis of urinary tract infection followrng transurethral resection of the prostate. Rev Infect Dis 1989; II (Suppl 5): S1354.
Volume 92 (suppl 4A)
CHARTON,
M.D., ANNICK
MOMBET,
M.D.,
BERNARO
GAITEGNO,
The purpose of this study was to compare the efficacy and safety of single-dose oral lomefloxacin and single-dose parenteral cefuroxime for the prevention of urinary tract infection following transurethral surgery. A total of 63 patients were enrolled in this prospective, randomized open-label study, which was conducted at two medical centers in France. Patients were randomized to receive either 400 mg of oral lomefloxacin 2-6 hours before surgery or 1.5 g parenteral cefuroxime 30-90 minutes before surgery. Postoperative clinical evaluation was performed daily, and bacteriologic evaluation included urine cultures performed 24 hours after surgery, just before and 1 day after removal of the indwelling catheter, and 3-5 days after surgery. Another urine culture was optionally performed l-3 months after surgery. Infection was defined as a urinary bacteria count ~10’ colony-forming units (CFU)/mL of urine. Of the 63 patients enrolled, 54 were evaluable for efficacy, 27 in each group. The success rate of prophylaxis was 88.9% in the lomefloxacin group and 88.5% in the cefuroxime group (p = nonsignificant). None of the 16 lomefloxacin-treated patients who were re-cultured at l-3 months was found to be infected. Adverse events were minor in both groups. A single oral dose of lomefloxacin was as efficacious and as safe as a single intravenous dose of cefuroxime for prevention of postoperative urinary tract infection in patients undergoing transurethral surgery.
From Centre Medico-Chirurgical Tenon (B.G.), Paris, France.
de la Porte de Choisy (M.C.A.M.) and Hdpital
Requests for reprints should be addressed to Michel Charton, M.D., C.M.C. de la Porte de Choisy, 6, place de Port au Prince, 75013 Paris, France.
4A-116s
April 6, 1992
The American Journal of Medicine
M.D.,
mis,
France
omefloxacin is a difluoroquinolone with an L elimination half-life of about8 hours. The prostate tissue:plasma concentration ratio for lomefloxacin 3.5 hours after oral administration was 2.0 [ll. A total of 70%of the ingesteddoseis eliminated in the urine in the first 24 hours, with high urine levels of active drug [2]. The concentrations of lomefloxacin in the prostatic tissue (and obviously in urine) are high enoughto eradicatethe majority of bacteriathat commonlycauseurinary tract infection following transurethral surgery. Lomefloxacin is efficaciousagainst gram-negativebacilli, including Enterobacteriaceae and Pseudomonas and against gram-positive cocci including staphylococci 131. Several studies [4-61 have demonstrated that, evenin patients with sterile urine, bacterial colonization of urethral mucosaand prostatic tissue exists. This fact probably explainsthe high incidence (about 35%) of urinary tract infection following transurethral surgery performedwithout antibiotic prophylaxis, as shown in the control groups of many studies comparing efficacy of a drug versus placeboin these surgical conditions [7-101. Many antibiotics of different classeshave been shown to prevent urinary tract infections occurring after transurethral prostate surgery [7-111 and transurethral bladder tumor ablation [4]. The pharmacokinetic properties of lomefloxacin andthe successof other fluoroquinolonederivatives as prophylactic agents in transurethral prostatectomy [11,12]led us to conducta randomizedstudy comparing the efficacy and safety of oral singledoselomefloxacinandintravenoussingle-dosecefuroxime to prevent urinary tract infection in patients with sterile urine undergoing transurethral surgery. PATIENTSAND METHODS A total of 63 adult (>18 years old) patients who were scheduledto undergo transurethral surgery were enrolled at two centers. The study was approved by the local ethics committee, and all patients provided written informed consent.Patients were required to have sterile urine within 48 hours before surgery. Women at risk of pregnancywere
Volume 92 (suppl 4A)
SYMPOSlUh!ON ONCE-A-DAYQUINOLONE/ CHARTONET AL
required to have a pregnancy test. Patients were excluded if they were pregnant, had a terminal illness, a history of convulsive disorders, valvular heart disease, serum creatinine >200 ,umol/L, liver function tests >.2 times the normal range, or a history of sensitivity to quinolones or cephalosporins. Patients were not enrolled if they had received any antimicrobial therapy within 2 weeks of study entry. Pretreatment evaluation, performed within 48 hours before surgery, included medical history and baseline physical examination, urine culture, and baseline clinical laboratory tests (within 48 hours prior to transurethral surgery). Patients were randomly assigned to groups receiving either 400 mg (two 200 mg capsules) of lomefloxacin orally 2-6 hours before transurethral surgery or 1.5 g of cefuroxime intravenously 30-90 minutes before the surgical procedure. The transurethral operations were done under strict surgical asepsis by means of cystoscope connected to a video camera device in an operating room. The perioperative irrigation solution was sterile 1.5% glycine in water. Postoperative drainage was ensured by a double-lumen catheter with continuous irrigation of sterile 0.9% saline solution in water. The urine was collected in a closed bag with an anti-reflux valve. Postoperatively, daily clinical examination was performed during the study, and all patients were clinically monitored and instructed to notify the investigator of any adverse event. Clinical laboratory tests were performed 3-5 days after transurethral surgery and compared to preoperative values. Urine cultures were obtained 24 hours after surgery, before the urinary catheter ablation, 1 day after the urinary catheter ablation, and 3-5 days after surgery. Another urine culture was optionally performed l-3 months after surgery. A positive urine culture was defined as a bacterial count >105 colony-forming units (CFU)/mL of urine. Blood cultures were performed if a patient had chills or temperature >38”C. The results of the two groups were compared by means of the chi-square test or Fisher’s t-test. The quantitative parameters were defined by the mean value and the standard deviation, and they were compared by Student’s t-test.
RESULTS Of the 63 patients enrolled, 32 were randomized to receive lomefloxacin and 31 to receive cefuroxime. There were no statistically significant differences in evaluable patient demographics (Table I) or in the types of surgical procedures (Table II). A total of 54 patients (2’7 in the lomefloxacin group
TABLE I Patient Demographics (Evaluable Patients)
Male/female Mean 1 Duration ageof(years1 urinary catheter (days)
Lomefloxacin ~ (n=27)
Cefuroxime ___ (n = 27)
p Value
67.67 25/2 t 9.0
68.67 26/l + 7.08
Iii
2.14 5 0.56
2.18 + 0.73
NS
NS = not srgndicant.
TABLE II Surgical Procedures (Evaluable Patients) Lomofloxacin Procedure
Cefuroxime
(n=27)
TUR prostate TUR bladder TUR prostate t bladder Ureteroscopy
(n=n)
:o’
17 8
i
1
p = not significant; TUR = transurethral resectlon.
TABLE Ill Reasons for Nonevaluability Lomefloxacin
Cefuroxime
(n = 32)
- (n = 31)
3
Postoperative indwellingcatheter >4 days Protocol violation Inclusion criteria not met Lost to followup
t, A
Total not evaluable Total evaluable
1
:
2:
2;
TABLE IV Bacteriologic Results Postoperative Preoperative
24 hours
Day l-Day
3
Lomefloxacin (n = 27) Not evaluable Infected Not infected
27(100%) 24(96%)
Cefuroxime (n = 27) Not evaluable Infected Not infected
27(100%) 26 (100%) 24 (92.3%)
Day 3-Day 5
2 i
i
1(4%1
A
;
25(100%) : (7.7%)
i (11.1%)
24(88.9%) &1.5%,
23(88.5%)
and 2’7 in the cefuroxime group) met the criteria for efficacy evaluation. Five patients in the lomefloxacin group and four, in the cefuroxime group were excluded from evaluation (Tables III and IV). The most frequent reason for exclusion was the use of an indwelling urinary catheter for >4 days. A total of 24 patients in the lomefloxacin group (88.9%) and 23 in the cefuroxime group (88.5%) had
April 6, 1992
The American Journal of Medicine
Volume 92 (suppl 4A)
4A-119s
SYMPOSIUM
ON 0NCE.A.DAY
QUINOLONE
/ CHARTON
ET AL
sterile urine throughout the study period (p = nonsignificant) (Table IV). There were six bacteriologic failures during the evaluation period, three in each group. Bacteriologic failures in the lomefloxacin group were attributed to coagulase-negative staphylococci, including Staphylococcus epidermidis (two patients), and Streptococcus agalactiae (one patient); failures in the cefuroxime group were attributed to Enterococcus sp. (one patient), Enterococcus faecalis (one patient), and Klebsiella pneumoniae plus Enterobacter cloacae (one patient). All the gram-positive cocci in the lomefloxacin group were resistant to lomefloxacin, and the E. faecalis in the cefuroxime group was resistant to cefuroxime, whereas the K. pneumoniae and E. cloacae in the cefuroxime group were moderately susceptible to cefuroxime. In the lomefloxacin group, one patient had a positive blood culture 24 hours after surgery (coagulase-negative staphylococci) and two patients had positive urine cultures (one with S. agalactiae and one with S. epidermidis) at the 3-5 day evaluation. One lomefloxacin patient had clinical signs of severe urinary tract infection (chills and fever of 39°C 1 day post-surgery). In the cefuroxime group, one patient was infected with E. cloacae and K. pneumoniae at days l-3 and days 3-5, one with Euterococcus sp. at days 1-3, and one with E. faecalis at days 3-5). There was one adverse event in each group: one patient in the cefuroxime group had pain at the site of the intravenous injection, and one patient in the lomefloxacin group complained of headache, but this was not considered by the investigator to be related to the study drug. There were no abnormal laboratory test values related to the prophylactic drugs. Follow-up was done at 4 weeks to 3 months for 33 patients, 16 in the lomefloxacin group and 1’7 in the cefuroxime group. Two patients in the cefuroxime
4A-120s
April 6, 1992
The American Journal of Medicine
group had urinary tract infections, one with Staphylococcus aureus, one with Escherichia coli. There was no infection in the lomefloxacin group.
CONCLUSION Lomefloxacin was as effective and well tolerated as cefuroxime when used as a prophylactic agent before transurethral surgery; however, lomefloxacin has an advantage in being administered orally, rather than via the usual parenteral route. Thus, lomefloxacin could be advantageously used in this indication.
REFERENCES 1. Kkmberg IW, Chrlds SJ, Madore RI, Kkmberg SR. A multicenter comparison of oral lomefloxacin versus parenteral cefotaxime as prophylacttc agents rn transurethral surgery. Am J Med 1992; 92 (Suppl 4A): 121-25. 2 Mornson PJ, Mant TGK, Norman GT, Robinson J, Kunka RL. Pharmacokrnebcs and tolerance of lomefloxacin after sequentrally Increasing oral doses. Antimicrob Agents Chemother 1989; 32: 1503-7. 3. Hirose T, Okezaki E, Kato H, Ito Y, lnoue M, Mitsuhashr S. In vitro and in vrvo activity of NY-198, a new drfluorinated quinolone. J Antimrcrob Chemother 1987: 31: 854-9. 4. Goldwasser B. Bogokowskr B, Native 0, Side AA, Jonas P, Many M. Urinary rnfections followrng transurethral resection of bladder tumors: rate and source. J Urol 1983; 129: 1123-4. 5. Gorelick JI, Senterfit LB, Vaughn ED Jr. Quantrtative bacterial tissue cuitures from 209 prostatectomy specimens: findrngs and Implications. J Urol 1988; 1: 57-60. 6. Robinson MRG, Arudpragasam ST, Saghal SM, Cross R, Fittal B, Sibbald R. Bactenuria resulting from prostahc surgery: the source of bacteria. Br J Ural 1982; 54: 542-6. 7. Botto Ii, Rrchard F, Mathieu F, Perreau AM, Camey M. Short- term prophylaxis with cefotaxime in prostatic surgery. J Antrmicrob Chermother 1984; 14 (Suppt 6): 231-5. 8. Charton M, Dosne B, Escovar P, Kopf A, Brisset JM. Trartement prophylactique minute des infections urinarres apres resection endoscopique de la prostate. Presse Med 1984; 13: 545-8. 9. Charton M, Vallanccen G, Veillon B, Bnsset JM. Anbbiotic prophylaxes of urinary tract infection after transurethral resection of the prostate: a randomrzed study. J Urol 1987; 138: 87-9. 10. Grabe M. Anhmicrobral agents in transurethral prostabc resectron. J Urol 1987; 138: 245-52. 11. Murdoch DA, Badenoch DF, Gatchalian ER. Oral ciprofloxacrn as prophylaxes rn transurethral resectron of the prostate. Br J Urol 1987; 60: 153-6. 12. Char-ton M, Mombet A, Prapotnich D. Ideal durabon of pefloxacin prophylaxis of urinary tract infection followrng transurethral resection of the prostate. Rev Infect Dis 1989; II (Suppl 5): S1354.
Volume 92 (suppl 4A)