Prostate Biopsy Medication

Updated: May 07, 2020
  • Author: Ahmed F El Shafei, MBBCh, MSc(Urol), PhD(Urol); Chief Editor: Edward David Kim, MD, FACS  more...
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Medication Summary

A single dose of a fluoroquinolone plus a single dose of parenteral gentamicin is indicated. Alternatively, a cephalosporin may provide adequate coverage, but this option has not been studied extensively.

Finally, all patients should receive a prostatic block. This may be done with any local anesthetic injectable agent. The benefits of prolonged local anesthesia have not been established.


Antibiotics, Other

Class Summary

Prophylactic therapy should cover all likely pathogens in the context of this clinical setting.

Ciprofloxacin (Cipro)

Ciprofloxacin is a fluoroquinolone that inhibits bacterial DNA synthesis and, consequently, growth, by inhibiting DNA gyrase and topoisomerases, which are required for replication, transcription, and translation of genetic material. Quinolones have broad activity against gram-positive and gram-negative aerobic organisms. Ciprofloxacin has no activity against anaerobes. The protocol may consist of a single dose of 500 mg ciprofloxacin.


Local Anesthetics, Amides

Class Summary

The use of a urethral anesthetic in female patients is controversial. The decision to anesthetize the urethra should be made in conjunction with the patient. Local anesthetics block the initiation and conduction of nerve impulses. Anesthetics used for the urethra include lidocaine and, possibly, bupivacaine.

Lidocaine (Xylocaine)

Lidocaine inhibits depolarization of type C sensory neurons by blocking sodium channels. The authors use 1% lidocaine without epinephrine.

Bupivacaine (Marcaine)

Bupivacaine decreases permeability to sodium ions in neuronal membranes. This results in the inhibition of depolarization, blocking the transmission of nerve impulses. The authors have used 0.25% bupivacaine successfully. Despite the traditional teaching that bupivacaine's onset of action is delayed in comparison with that of lidocaine, the authors have found that this is not the case and that the 2 agents work equally well.