Page 48 - Ebook-Book JCMS 2025

Effect of Antibiotic Prophylaxis After Flexible Cystoscopy to
Prevent Symptomatic Urinary Tract Infection: A Randomized
Controlled Trial
Atiya Seeluangsawat, Supoj Ratchanon*
Faculty of Medicine, Chulalongkorn University
*Corresponding Author E-mail: supoj.r@chula.ac.th
Abstract
Background: Methods: Results: Conclusions: Urinary tract infection (UTI) symptoms are a common complication following flexible
cystoscopy. Although the European Association of Urology (EAU) and the American
Urological Association (AUA) do not recommend routine antibiotic prophylaxis for patients
without risk factors, a survey revealed that over 90% of urologists at King Chulalongkorn
Memorial Hospital (KCMH) and approximately 60% of Thai urologists routinely prescribe
antibiotics for all cystoscopy patients, even in low-risk cases. This study aims to examine
the necessity of antibiotic prophylaxis after flexible cystoscopy in Thailand.
This randomized controlled non-inferiority trial (with a 4.9% margin) involved 284 patients
at the outpatient cystoscopy unit of the Department of Urology, KCMH, Thailand, conducted
between August 2024 and January 2025. Patients without risk factors were enrolled and
randomly divided into two groups: one group received oral cefixime and the other group did
not receive any antibiotics. Symptoms of UTI were assessed through phone calls on the 7th
day following the procedure. The primary outcome of this study was to determine whether
low-risk patients without antibiotic prophylaxis experienced an increased incidence of
UTI symptoms after flexible cystoscopy. The secondary outcome was to investigate the
prevalence of UTI following flexible cystoscopy at KCMH.
A total of 265 patients were included. The results showed that 3.85% of patients who
received antibiotic prophylaxis developed UTI symptoms, while 96.15% were asymptomatic.
In contrast, 5.93% of patients who did not receive antibiotic prophylaxis developed UTI
symptoms, while 94.07% remained asymptomatic (RR 1.54, 95% CI: 0.52–4.59). These
findings demonstrate the non-inferiority of UTI symptoms in patients who did not receive
antibiotic prophylaxis compared to those who did after flexible cystoscopy.
Antibiotic prophylaxis after flexible cystoscopy may be omitted in low-risk patients.
Trial Registration: TCTR ID : TCTR20250402004
46 Joint Conference in Medical Sciences 2025