Description
This monograph gives an excellent review of the issue of antimicrobial prophylaxis in urol ogy and the use of the new fluoroquinolones in urology. The development of the fluoro quinolones has had a profound effect in urology, specifically because of the unique phar macokinetics of the fluoroquinolones with their two or more pK values, making concen tration of these compounds possible in the prostate. Their wide spectra against infecting organisms causing infections in the urinary tract have also made them popular and almost ideal in the treatment of urinary tract infections. This thesis summarizes in an concise way and brings up to date practically all our know ledge concerning the use of fluoroquinolones in urology. The chapter on antimicrobial prophylaxis covers our present knowledge completely, especially concerning the use of these drugs in antimicrobial prophylaxis in transurethral surgery. September 1992 PaulO. Madsen Madison, Wisconsin, USA v Contents Preface. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . V I. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 1. 1. Author’s Publications Referred to in Text . . . . . . . . . . . . . . . . . . . . . . 1 1. 2. Historical Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 1. 3. Problems of Antimicrobial Prophylaxis in Urology . . . . . . . . . . . . . . . . 2 D. General Considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 2. 1. Definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 2. 1. 1. Bacteriuria and urinary tract infections . . . . . . . . . . . . . . . . . . . . . . 3 2. 1. 2. Bacteremia and septicemia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 2. 1. 3. Nosocomial infections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 2. 1. 4. Wound infections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 2. 2. Pathophysiology of Infection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 2. 3. Specifics of Antimicrobial Agents to be Used in Prophylaxis . . . . . . . . . . 6 2. 4. Role of Quinolones . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 2. 4. 1. Antimicrobial activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 2. 4. 2. Pharmacokinetic properties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I. Introduction.- 1.1. Author’s Publications Referred to in Text.- 1.2. Historical Background.- 1.3. Problems of Antimicrobial Prophylaxis in Urology.- II. General Considerations.- 2.1. Definitions.- 2.1.1. Bacteriuria and urinary tract infections.- 2.1.2. Bacteremia and septicemia.- 2.1.3. Nosocomial infections.- 2.1.4. Wound infections.- 2.2. Pathophysiology of Infection.- 2.3. Specifics of Antimicrobial Agents to be Used in Prophylaxis.- 2.4. Role of Quinolones.- 2.4.1. Antimicrobial activity.- 2.4.2. Pharmacokinetic properties.- 2.4.3. Side effects.- 2.4.4. Uncomplicated urinary tract infection.- 2.4.5. Complicated urinary tract infection.- 2.4.6. Bacterial prostatitis.- 2.5. Cost-Benefit Analysis of Antimicrobial Prophylaxis.- III. In Vitro Studies.- 3.1. Minimal Inhibitory Concentrations (MIC).- 3.2. Influence of Various Factors on MIC.- IV. Animal Studies.- 4.1. Drug Penetration into Various Tissues.- 4.2. Timing, Dosing, and Duration Studies.- 4.3. Bladder Irrigation Studies.- V. Human Studies and Review of the Literature.- 5.1. Catheterization and Urethral Dilatation.- 5.2. Endourologic Procedures.- 5.2.1. Cystoscopy.- 5.2.2. Internal urethrotomy.- 5.2.3. Transurethral resection of the prostate (TURP).- 5.2.4. Transurethral resection of bladder tumors (TURB).- 5.2.5. Ureterorenoscopy (URS).- 5.2.6. Percutaneous surgery.- 5.3. Open Surgery.- 5.3.1. Surgery of kidneys and external genitalia.- 5.3.2. Open prostatectomy.- 5.3.3. Cystectomy with urinary diversion.- 5.3.4. Kidney transplantation.- 5.4. Various Urologic Procedures.- 5.4.1. Biopsy of the prostate.- 5.4.1.1. Transrectal biopsy.- 5.4.1.2. Transperineal biopsy.- 5.4.2. Extracorporeal shock wave lithotripsy (ESWL).- 5.5. Various High-Risk Conditions.- 5.5.1. Situations predisposing to infection.- 5.5.2. Patient characteristics predisposing to infection.- VI. Literature.- VII. Summary.- VIII. Acknowledgements.- IX. Reprints of Papers I – VII.
