Comparison of Infectious Complications After Transrectal Prostate Biopsy Under Two Antibiotic Prophylaxis Regimens: Ceftriaxone Plus Cefixime Versus Ciprofloxacin Plus Gentamicin

ABSTRACT Objectives To compare the effectiveness and safety of two antibiotic prophylaxis regimens, ciprofloxacin plus gentamicin and ceftriaxone plus cefixime, in preventing infectious complications after transrectal ultrasound‐guided prostate biopsy. Methods The study retrospectively reviewed 705 consecutive patients who underwent transrectal ultrasound‐guided prostate biopsy between January 2020 and January 2024. Group 1 ( n = 374) received ciprofloxacin plus gentamicin, and Group 2 ( n = 331) received ceftriaxone plus cefixime. All patients underwent standard rectal preparation with povidone‐iodine, and needle‐tip disinfection with formalin. The primary outcome was the development of post‐biopsy infectious complications, while secondary outcomes included sepsis and infection‐related hospitalization. Results The two groups were comparable in terms of age, body mass index, prostate‐specific antigen levels, and comorbidities. The overall rate of post‐biopsy infection was 1.4%, occurring in 1.1% patients in Group 1 and 1.8% patients in Group 2 ( p = 0.61). The incidence of complicated urinary tract infection was 0.3% versus 0.9%, and infection‐related hospitalization occurred in 0.5% versus 0.3% of patients in Group 1 and Group 2, respectively, with no cases of sepsis observed. In univariable analyses, diabetes mellitus, histopathological chronic prostatitis, and pre‐biopsy antibiotic use were not significantly associated with post‐biopsy infection. Conclusion The combination of ceftriaxone and cefixime showed a safety profile broadly consistent with the combination of ciprofloxacin and gentamicin for biopsy prophylaxis. Considering increasing fluoroquinolone resistance and growing restrictions, this cephalosporin‐based regimen may be considered a feasible option for transrectal ultrasound‐guided prostate biopsy when implemented together with strict antiseptic measures.