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Trends in antibiotic use after routine ureteroscopic stone treatment
Michael P. Kurtz, MD, Brian H. Eisner, MD.
Massachusetts General Hospital, Boston, MA, USA.

BACKGROUND: Antibiotic resistance is an important public issue which is increasing in prevalence. In particular, fluoroquinolone resistance continues to become more problematic. The AUA guidelines for antibiotic use recommends antibiotic treatment for 24 hours after ureteroscopy. We performed this study to examine urologists' compliance with these guidelines.
METHODS:A nine question online survey was created and was sent to the members of the members of the Endourological Society. Characteristics of the respondents are as follows: One hundred fifty (150) urologists responded to the survey. Years in practice were 1-4 years (16.8%), 5-9 years (20.8%), 10-19 years (30.2%), and 20+ years (32.2%). Practice type was academic (71.3%), Private practice (27.7%), and military (2.7%).
RESULTS:Mean number of ureteroscopic stone treatments per year was 118 (SD 123). Preoperative antibiotics were given in 97.6% of cases. For uncomplicated ureteroscopy in which a stent with a pull-out string was placed, duration of post-operative antibiotic treatment ranged from 0-7 days. A majority of urologists (69.5%) gave antibiotics for > 24 hours after ureteroscopy (24-47 hours = 7.8%, 48-71 hours = 21.9%, 72-95 hours = 15.6%, 96 hours - 1 week = 15.6%). A minority were compliant with the AUA guidelines (no post-operative antibiotics = 22.7%, < 24 hours = 7.8%). The most common antibiotics prescribed were fluoroquinolones (56.8%), sulfa (13.6%), penicillin/cephalosporin (9.1%), and nitrufurantoin (3.8%).
CONCLUSIONS:A majority of urologists in this survey do not follow the published AUA antibiotic guildelines when performing uncomplicated ureteroscopy (when leaving stent with pull out string). Post-operative antibiotic treatment exceeded 24 hours in nearly 70% of these cases. Future randomized clinical trials may be useful to determine the true utility (if any) of post-operative antibiotics after ureteroscopy.


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