- Author: Gamal Mostafa Ghoniem, MD, FACS; Chief Editor: Edward David Kim, MD, FACS more...
The goals of pharmacotherapy are to reduce morbidity and prevent complications.
Local Anesthetics, Amides
Local anesthetics block the initiation and conduction of nerve impulses. Anesthetics used for the cystoscopy include lidocaine.
Lidocaine inhibits depolarization of type C sensory neurons by blocking sodium channels. Instill local lidocaine gel into the urethra 10-15 minutes before the procedure.
Those who prefer a rigid cystoscope or are performing an office procedural cystoscopy that necessitates the use of a rigid cystoscope typically instill local lidocaine gel into the urethra 10-15 minutes before the procedure. Some studies support the use of lidocaine spray, which takes effect more quickly (within 1-5 min). This option may reduce anxiety in patients waiting for the procedure, as well as save time in the setting of a busy clinic.
The recommended antibiotic prophylaxis includes a single dose of either a fluoroquinolone or trimethoprim-sulfamethoxazole. Alternatively, an aminoglycoside (with or without ampicillin), a first- or second-generation cephalosporin, or amoxicillin-clavulanate may be administered. Patients with negative urine cultures and those without any of these risk factors do not need antibiotic prophylaxis before cystourethroscopy.
Trimethoprim blocks dihydrofolate reductase, and sulfamethoxazole inhibits bacterial synthesis of dihydrofolic acid by competing with para-aminobenzoic acid (PABA). These are 2 sequential steps in bacterial biosynthesis of nucleic acids and proteins. This agent is available in single- and double-strength form. In adults, it is most commonly taken in pill form, although a liquid suspension is available.
A derivative of pyridine carboxylic acid with a broad-spectrum bactericidal effect, levofloxacin penetrates the prostate well and is effective against Neisseria gonorrhoeae and Chlamydia trachomatis.
Ciprofloxacin is a fluoroquinolone with activity against pseudomonads, streptococci, methicillin-resistant Staphylococcus aureus (MRSA), Staphylococcus epidermidis, and most gram-negative organisms, but no activity against anaerobes. It inhibits bacterial DNA synthesis and, consequently, growth. It diffuses into prostatic fluid and is indicated for chronic prostatitis.
Ampicillin has bactericidal activity against susceptible organisms. It is an alternative to amoxicillin when the patient is unable to take medication orally.
Amoxicillin is an ampicillin analogue with broad-spectrum bactericidal activity against many gram-positive and gram-negative organisms.
Cefuroxime is a second-generation cephalosporin that maintains the gram-positive activity of the first-generation cephalosporins and adds activity against Proteus mirabilis, Haemophilus influenzae, Escherichia coli, Klebsiella pneumoniae, and Moraxella catarrhalis. The condition of patient, the severity of the infection, and the susceptibility of the microorganism determine the proper dose and route of administration.
Cefprozil binds to 1 or more of the penicillin-binding proteins, and this binding, in turn, inhibits cell wall synthesis and results in bactericidal activity.
Cephalexin is a first-generation cephalosporin that arrests bacterial growth by inhibiting bacterial cell wall synthesis. It has bactericidal activity against rapidly growing organisms. The primary activity of cephalexin is against skin flora; the drug is used for skin infections or prophylaxis in minor procedures.
Gentamicin is an aminoglycoside antibiotic for gram-negative coverage of bacteria, including Pseudomonas species. It is synergistic with beta-lactamase against enterococci. Gentamicin interferes with bacterial protein synthesis by binding to 30S and 50S ribosomal subunits. Dosing regimens are numerous and are adjusted based on creatinine clearance and changes in volume of distribution, as well as the body space into which the agent needs to distribute. Monitor gentamicin by serum levels obtained before the third or fourth dose (0.5 h before dosing); the peak level may be drawn 0.5 hour after a 30-minute infusion.
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