Which antibiotic prophylaxis to use for urologic procedures in patients at risk for infective endocarditis: a report on two cases.

In urologic surgery, antibiotic prophylaxis is generally recommended for transrectal prostate biopsies and transurethral prostate resection. While a fluoroquinolone (such as ciprofloxacin or levofloxacin) may be appropriate in most instances, patients at risk for infectious endocarditis (IE) may require a different regimen, effective also against Enterococcus species. We describe and comment on the cases of two patients who, following urologic procedures and antibiotic prophylaxis, developed Enterococcus faecalis endocarditis. We also propose an antibiotic prophylactic regimen for urologic procedures suitable for patients at risk for infectious endocarditis (IE).