Comparison of Antibiotic Prophylaxis Regimens for Preventing Prostatitis After Transrectal Ultrasound-Guided Prostate Biopsy.

BACKGROUND: Transrectal ultrasound (TRUS)-guided prostate biopsy is a common way to find prostate cancer, but it can lead to infections, including sepsis. Fluoroquinolones have historically served as a means of antibiotic prophylaxis; however, escalating resistance has diminished their efficacy, thereby requiring alternative prophylactic approaches. OBJECTIVE: To compare infectious outcomes after TRUS-guided prostate biopsy across various antibiotic prophylaxis regimens and to evaluate the efficacy of single-dose intramuscular (IM) ertapenem and amikacin. METHODS: This retrospective observational study encompassed patients who underwent TRUS-guided prostate biopsy from January 2015 to June 2025 at two hospitals in Lebanon. We looked at the patients' demographics, clinical characteristics, laboratory data, antibiotic prophylaxis regimens, and post-biopsy infectious complications. We used bivariate analysis and multivariable logistic regression to find links between prophylaxis strategies and the risk of infection. RESULTS: There were 209 patients in total, with an average age of 66.7 years and an average prostate-specific antigen level of 18.2 ng/mL. In total, 12.9% of patients had infections after the biopsy. Patients who received single-dose IM ertapenem, either alone or in combination with fluoroquinolones, did not experience any infections. The infection rate for patients who got a single dose of IM amikacin was 3.8%, while the rate for patients who got fluoroquinolone monotherapy was 26%. Single-dose IM ertapenem or amikacin was linked to a lower risk of infection than fluoroquinolone-based prophylaxis (p < 0.05). There was no meaningful distinction between ertapenem and amikacin, nor between single-agent and combination regimens. Older age and a history of positive urine culture were strongly linked to post-biopsy infection. CONCLUSION: A single dose of IM ertapenem or amikacin appears to be associated with a lower risk of infections after a TRUS-guided prostate biopsy. They may represent a potential prophylactic alternative to fluoroquinolone-based regimens, especially in places where routine rectal culture-guided prophylaxis is not done.