Antimicrobial Prophylaxis in Urology with special reference to the new Quinolones

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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . von Gasser, Thomas