Prolonged antibiotic courses have no benefit after PCNL for infectious stones

U.S.A.: According to a report published in the International Journal of Urology, neither two weeks nor twelve weeks of postoperative oral antibiotics are preferable to prevent stones and recurrent positive urine cultures for individuals who have had stones removed by percutaneous nephrolithotomy.

PCNL (percutaneous nephrolithotomy or stone extraction) is a minimally invasive approach of treating kidney and ureteral stones that are too big (often greater than 2 centimeters), multiple, or too dense to be managed by extracorporeal shock wave lithotripsy (ESWL) or ureteroscopy.

"Complete surgical stone removal for struvite kidney stones is necessary for treatment, along with antibiotic therapy to get rid of UTIs and preventative steps to lessen stone recurrence. Unknown is the ideal time frame for receiving antibiotics," the authors stated.

The purpose of this research was to compare the results for stone recurrence and positive urine cultures after 2- or 12-weeks of antibiotic treatment following percutaneous nephrolithotomy (PNL) for infection stones.

A multi-center, prospective randomized trial evaluating individuals with the clinical diagnosis of infection stones was conducted to achieve this objective. Patients were included if remaining fragments were less than 4 millimeters on computed tomography imaging following PNL and were randomly assigned to receive 2- or 12-weeks of postoperative oral antibiotics (nitrofurantoin or culture-specific antibiotic). At 3, 6, and 12 months after the surgery, imaging and urine tests were conducted. Following PNL, 38 patients were enrolled and randomly assigned to receive antibiotic therapy for either 2 weeks (n = 20) or 12 weeks (n = 18). Due to remaining pieces larger than 4 mm, 11 patients were disqualified, and 3 patients were lost to follow-up. The stone-free rate (SFR) at 6 months after PNL was the main result.

Conclusive points:

• At 3-, 6-, and 12-month follow-up, the SFRs between the 2- and 12-week groups were 72.7% versus 80.0%, 70.0% versus 57.1%, and 80.0% versus 57.1% (p = ns), respectively.
• Positive urine cultures at 3-, 6-, and 12-month follow-ups were 50.0% versus 37.5%, 50.0% versus 83.3%, and 37.5% versus 100%, respectively (p = ns).

The authors concluded that this study demonstrates that prolonged post-PCNL antibiotic courses do not offer greater protection in individuals being treated for infectious stones.

They emphasized that larger investigations are required to ascertain whether there are any clinically significant differences between these treatment techniques on a smaller scale.

REFERENCE

Chew, B.H., Reicherz, A., Krambeck, A.E., Miller, N.L., Hsi, R.S., Scotland, K.B., Miller, D., Paterson, R.F., Wong, V.K.F., Semins, M.J. and Lange, D. (2022), Prospective randomized trial of 2 versus 12-weeks of postoperative antibiotics after percutaneous nephrolithotomy in complex patients with infection-related kidney stones. Int. J. Urol..https://doi.org/10.1111/iju.15045