Transrectal Ultrasonography of the Prostate Medication

Updated: Aug 04, 2016
  • Author: Sugandh Shetty, MD, FRCS; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Medication

Medication Summary

The goals of pharmacotherapy are to reduce pain and morbidity and prevent complications.

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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.

Lidocaine (Xylocaine)

Currently, however, it is a common practice to infiltrate lidocaine into the periprostatic area. Administer 2.5 mL of lidocaine on each side at the prostate base at the junction of the prostate and the seminal vesicle (using a 5-in, 22-gauge spinal needle through the ultrasound probe).

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Antibiotics, Other

Class Summary

More than 90% of urologists administer prophylactic oral antibiotics. There is increasing support for a simple prophylactic regimen in patients with uncomplicated medical conditions.

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 2 doses of 500 mg ciprofloxacin, with the first given before the procedure and the second 12 hours later.

Ampicillin and sulbactam (Unasyn)

In patients with prosthetic implants or valvular heart disease, prophylaxis with ampicillin 1 g intramuscularly (IM) may be administered. Ampicillin interferes with bacterial cell wall synthesis during active replication, causing bactericidal activity against susceptible organisms. It covers skin, enteric flora, and anaerobes but is not ideal for nosocomial pathogens.

Gentamicin

In patients with prosthetic implants or valvular heart disease, prophylaxis with gentamicin 80 mg IM plus vancomycin 1 g intravenously (IV) is recommended. Gentamicin is an aminoglycoside antibiotic for gram-negative coverage. It is used in combination with an agent against gram-positive organisms and one that covers anaerobes.

Vancomycin

In patients with prosthetic implants or valvular heart disease, prophylaxis with vancomycin 1 g intravenously (IV) plus gentamicin 80 mg IM is recommended. Vancomycin is a potent antibiotic directed against gram-positive organisms and active against Enterococcus species. It is useful in the treatment of septicemia and skin structure infections.

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