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Perioperative Antibiotic Prophylaxis

Category: Pharmacology > Infection & Prophylaxis Last updated: September 2026

Overview​

Perioperative antibiotic prophylaxis aims to reduce surgical site infection (SSI) by achieving adequate tissue and urinary antibiotic concentrations at the time of incision. The foundational guidance for urologic prophylaxis is the AUA Best Practice Statement (BPS) 2020 on urologic procedures and antimicrobial prophylaxis[1] and the ASHP/IDSA 2013 antimicrobial prophylaxis in surgery guideline.[2]

In a retrospective PUMP cohort of 4,161 primary IPP placements, vancomycin plus gentamicin alone (one AUA BPS option; 2,411 patients) was associated with a higher adjusted hazard of postoperative infection than other regimens (1,750 patients) (HR 2.7; 95% CI 1.4–5.4), although crude infection rates were similar (1.0% versus 1.2%).[4] See Penile implants — infection and Prosthetic infection & biofilm protocols for the full device-specific detail.

Mechanism of Action​

Perioperative prophylaxis provides time-limited antimicrobial coverage during the window of maximum contamination risk, from skin incision to closure. The mechanistic requirements are:

  1. Adequate tissue concentration at time of incision, which requires correct timing
  2. Broad enough coverage for expected contaminants, with agent selection by procedure type
  3. Sufficient duration to cover the operative window, with redosing according to intravascular half-life
  4. Short enough total exposure to preserve microbiome and avoid resistance, meaning single-dose or <24-hour courses

Agents Used​

AgentPrimary roleTypical dose (normal renal function)Redose interval
CefazolinWorkhorse for most urologic procedures; skin + common gram-negatives2 g IV (3 g if ≥120 kg)q4h
VancomycinSelected MRSA coverage or a β-lactam reaction that precludes cefazolin after allergy assessment; routine vancomycin is discouraged, and ASHP reports lower efficacy than cefazolin for MSSA SSI prevention[2][20][21]15 mg/kg IVUsually no intraoperative redose[1][2]
GentamicinGram-negative coverage; paired with cefazolin or another first-/second-generation cephalosporin for implanted prostheses (AUA BPS Table V; aztreonam substitutes in renal insufficiency)5 mg/kg IV on dosing weight (single dose)Single dose typically[1][2]
Piperacillin-tazobactamBroad gram-negative + anaerobic coverage; urinary diversion / bowel-involving cases3.375 g IVq2h
CeftriaxoneColorectal-entry regimens, combined with metronidazole; long half-life2 g IVLong t½ — single dose usually sufficient
MetronidazoleAnaerobic coverage — combine with cephalosporin for bowel cases500 mg IVUsually no intraoperative redose[2]
Clindamycinβ-lactam allergy; skin coverage900 mg IVq6h[2]
Ciprofloxacin / levofloxacinOral or IV option for endoscopic GU procedures when local susceptibility supports it; see fluoroquinolone cautions belowCiprofloxacin 400 mg IV or levofloxacin 500 mg IVUsually no intraoperative redose for typical case length; unusually long procedures may need redosing[2]
AztreonamGram-negative alternative; check ceftazidime allergy because of shared side chain2 g IVq4h

Adult reference doses and redosing intervals above follow ASHP guidance for normal renal function; intervals run from the start of the preceding dose. Gentamicin is dosed on actual body weight; when actual weight exceeds ideal body weight (IBW) by more than 20%, use the dosing weight IBW + 0.4 × (actual − IBW).[2] Cefazolin rises to 3 g at 120 kg or more (ASHP notes 2 g is reasonable above 80 kg). Antifungal selection is discussed in the device and antifungal hubs; in a retrospective IPP cohort, perioperative IV antifungal use was associated with lower postoperative infection odds.[5]

Indications in Urology — AUA BPS 2020 Framework​

The AUA BPS categorizes urologic procedures by infection risk. Single-dose perioperative prophylaxis is the standard for most clean-contaminated procedures.[1]

Choose by procedure, culture and local susceptibility​

ProcedureProphylaxis framework
TURP / HoLEPAUA Table V lists single-dose prophylaxis for transurethral cases, including TURP and laser enucleation: cefazolin or TMP-SMX; alternatives amoxicillin-clavulanate, an aminoglycoside ± ampicillin, or aztreonam ± ampicillin. EAU 2026 strongly recommends prophylaxis for TURP without specifying a single-dose regimen. Adjust to culture and local guidance.[1][19]
TURBTAUA supports single-dose prophylaxis; EAU makes a weak recommendation for prophylaxis in patients at high risk of postoperative sepsis (systematic-review evidence of benefit is limited)
Ureteroscopy / PCNLIdentify and treat preoperative infection / bacteriuria. Ureteroscopy: AUA Table V lists all cases (benefit undetermined for uncomplicated diagnostic ureteroscopy), TMP-SMX or a first-/second-generation cephalosporin, single dose; EAU weak. PCNL: cephalosporin-based regimen for under 24 hours (AUA); EAU strong for a single dose
UrethroplastyEAU 2026 strongly recommends intraoperative antibiotic prophylaxis for urethral surgery and recommends treating preoperative infection or colonization. AUA Table V lists cefazolin, with cefoxitin, cefotetan or ampicillin-sulbactam as alternatives, single dose. Buccal harvest or a perineal incision alone does not justify prolonged postoperative antibiotics, including through catheter removal.[27]
Sling / mesh / sacrocolpopexyVaginal surgery for incontinence: single dose; AUA Table V lists a second-generation cephalosporin (cefoxitin, cefotetan) but states cefazolin gives equivalent vaginal-anaerobe coverage in sling procedures. Follow the relevant vaginal / abdominal protocol; merely entering the peritoneum does not itself require added anaerobic coverage. The placebo-controlled midurethral-sling trial was halted at its first scheduled interim analysis because infectious outcomes were infrequent, after enrolling 59 women; wound infection (cefazolin 1 [3.3%] versus placebo 0), mesh exposure (0 versus 1 [3.5%]) and bacteriuria (3 [10%] versus 1 [3.5%]) did not differ significantly.[30]
IPP / AUSStandard perioperative prophylaxis remains indicated; the BPS advises covering coagulase-negative staphylococci and gram-negative bacilli including Pseudomonas. AUA Table V (implanted prostheses including AUS, IPP and sacral neuromodulators): an aminoglycoside plus a first-/second-generation cephalosporin, aztreonam plus the cephalosporin, or vancomycin paired with an aminoglycoside or aztreonam (a footnote states that routine vancomycin is not recommended); the AUA alternative column includes an aminopenicillin with a β-lactamase inhibitor.[1] ASHP separately lists clindamycin with or without an aminoglycoside or aztreonam for patients with β-lactam allergy.[2] Table V gives a duration of under 24 hours, while the BPS text advises no doses after closure. ASHP: cefazolin, with a single aminoglycoside dose considered for penile prosthesis. See device-specific discussion
Cystectomy / bowel-containing diversionMatch coverage to bowel segment, obstruction/contamination and local protocol; a nonobstructed small-bowel segment and colorectal entry are not identical exposures. Small-bowel segments (AUA Table V): cefazolin, single dose. When colon or rectum is entered, provide aerobic and anaerobic coverage (ASHP reports postoperative SSI rates ranging from 12% to 39% across colorectal studies using a first-generation cephalosporin alone).[1][2] For surgery involving the colorectum, including colon conduits, AUA Table V lists cefazolin, cefoxitin, cefotetan or ceftriaxone, each paired with metronidazole, or ertapenem as a single parenteral dose; it pairs these IV options with mechanical bowel preparation and oral neomycin plus erythromycin base or metronidazole.[1] EAU 2026 advises against mechanical bowel preparation in its general SSI guidance and makes a Strong recommendation against preoperative bowel preparation before radical cystectomy.[19][31]

A separate randomized trial examined a postoperative UTI endpoint rather than wound infection: 159 women were enrolled; after eight protocol exclusions, 151 were randomized and 149 were analyzed (nitrofurantoin 100 mg twice daily for three postoperative days, n = 74; placebo, n = 75). UTI within 6 weeks occurred in 17.6% of the nitrofurantoin group versus 32% with placebo (P = .04); 37 of 149 participants (24.8%) had a UTI overall.[24]

Procedures usually not requiring prophylaxis​

Healthy, low-risk adults generally do not require prophylaxis for simple cystoscopy or routine urodynamics .[19] Intradetrusor onabotulinumtoxinA injection is a separate procedure: the US adult-bladder BOTOX label requires no active UTI and specifies non-aminoglycoside antibiotic prophylaxis 1–3 days before injection, on the injection day and 1–3 days afterward; see the intradetrusor injection page.[28] The BPS makes an exception for urodynamics: give a single dose (trimethoprim-sulfamethoxazole is the named agent; first- or second-generation cephalosporin, amoxicillin-clavulanate or an aminoglycoside are alternatives) in neurogenic lower urinary tract dysfunction, immunosuppression, known or suspected urinary tract abnormality with recent instrumentation, or recent antimicrobial use. Routine catheter exchange does not become an antibiotic indication merely because asymptomatic bacteriuria is present, although the BPS allows a dose at catheter, stent or nephrostomy-tube removal or a trial of void when other risk factors are present. SWL without bacteriuria or suspected infection generally does not require prophylaxis. Check patient-specific infection risks and the actual procedure.[1][3][7][19]

Preoperative urine culture and asymptomatic bacteriuria​

The AUA BPS 2020 advises that urinary symptoms suggestive of infection be evaluated before any urologic procedure with dipstick, microscopy and/or formal culture, scaled to procedural risk.[1] The AUA BPS advises accompanying microscopy when obtaining a urine culture because of common contamination and colonization; EAU urethral-stricture guidance allows urinalysis to be omitted when a preoperative urine culture is obtained for urethral surgery.[1][27] Defer elective procedures when active infection requires treatment. For urgent infection or obstruction, obtain cultures when feasible and start appropriate treatment and source control; do not delay necessary drainage while waiting for susceptibility results.[1]

The IDSA asymptomatic-bacteriuria guideline (2019)[7] provides the cleanest framework:

Clinical scenarioIDSA 2019 recommendationStrength / evidence
Endoscopic urologic procedure with mucosal trauma (TURP, TURBT, URS)Screen for and treat ASBStrong / Moderate
Prior to AUS or penile prosthesis implantationDo not routinely screen or treat ASB; still give standard perioperative prophylaxisWeak / Very low
When treating ASB before a GU procedureUse culture-targeted therapy, not empiricWeak / Very low
Duration when treating ASB for GU procedure1–2 doses starting 30–60 min preop; not a prolonged courseWeak / Low

The prosthetic-device exception exists because implant infections are typically caused by biofilm-producing skin flora rather than urinary pathogens; in a retrospective series of 721 AUS and IPP procedures, the 454 with preoperative urine cultures had similar device-infection rates with and without bacteriuria (3% vs 4.3%) at a median 15 months of follow-up, and only 1 of 15 device infections matched the preop urine organism.[7]

In the retrospective multicenter TOCUS cohort (2,389 patients), positive preoperative urine cultures and prior UTI were associated with febrile UTI or SSI within 30 days.[14]

Device-Specific Protocols​

IPP: retrospective multicenter PUMP analyses found associations between regimen choice and infection. In a retrospective cohort of 5,261 primary or revision IPP procedures at 16 centers, perioperative IV antifungal use was associated with lower adjusted odds of postoperative IPP infection (OR 0.22; 78% lower odds).[5] Prolonged IV prophylaxis and postoperative oral antibiotics have not shown a clear preventive benefit in these observational studies.[4][5][6]

IPP and AUS. In a national cohort of 26,574 IPP procedures, nonstandard or excess antibiotics were not independently associated with 90-day explantation.[12] In a national cohort of 9,775 primary AUS procedures, AUA-adherent prophylaxis was associated with fewer overall complications (OR 0.83; 95% CI 0.74–0.93) and revisions (OR 0.85; 95% CI 0.74–0.96) within 3 months, while the infection-specific association was not significant (OR 0.89; 95% CI 0.68–1.17).[13]

Use the prosthetic infection & biofilm hub for the device-specific evidence and manufacturer handling restrictions. InhibiZone and hydrophilic devices have different preparation requirements; do not transfer a dip or irrigation recipe between products. Operative handling belongs on the implant infection page.

Prostate biopsy — current EAU 2026 guidance​

EAU 2026 strongly recommends transperineal biopsy for its lower infectious risk and antibiotic stewardship and weakly recommends omitting perioperative antibiotics in transperineal biopsy patients without risk factors for infectious complications.[19]

The NORAPP trial randomized 555 patients; 553 were analyzed (277 prophylaxis, 276 none). Neither group had sepsis or UTI requiring hospitalization. Outpatient UTI occurred in 1/277 versus 3/276. The prespecified noninferiority margin was 4%; patients with high infection risk or ongoing infection were excluded.[9]

Transrectal biopsy: use rectal povidone-iodine preparation plus locally appropriate prophylaxis. EAU 2026 strongly recommends rectal-swab or stool-culture-guided prophylaxis first and augmented prophylaxis second for transrectal biopsy, and strongly recommends against fluoroquinolones for prostate biopsy, in line with the European Commission decision; most targeted-prophylaxis trials used fluoroquinolones.[19] Fosfomycin requires local regulatory and safety review; its prostate-biopsy indication was withdrawn in Germany. These recommendations supersede treating older fluoroquinolone-duration or fosfomycin analyses as a universal regimen.[19]

The Pilatz 2020 review (59 RCTs, 14,153 participants) supported antibiotic prophylaxis and targeted over empirical regimens, but rated certainty low or very low. Increasing fluoroquinolone resistance remains a reason to use current local susceptibility data.[8][17]

Radical cystectomy — duration of prophylaxis​

Cystectomy with urinary diversion is frequently associated with prolonged (>48 h) prophylaxis in practice. Duration evidence differs by endpoint and approach: the 2024 open-cystectomy RCT supports 24-hour prophylaxis for 90-day SSI, while a small 2025 robot-assisted-cystectomy RCT found fewer symptomatic 90-day UTIs after 30 days of postdischarge nitrofurantoin or TMP-SMX (0/37 versus 10/40 with usual care).[10][25]

Thurnheer 2024 (JAMA Network Open, single-center RCT, 193 patients) found 24-hour PAP noninferior to an extended course (median 8 days, until catheter/stent removal). Ninety-day SSI occurred in 8.4% versus 12.2%; risk difference −3.8% (90% CI −11.1% to 3.4%), within the prespecified 10% noninferiority margin.[10]

Mohamed 2026 (systematic review and meta-analysis, 4 studies, n = 680):[11]

  • No statistically significant difference detected between short-term (≤24 h) and extended PAP on:
    • SSI: RR 0.71 (95% CI 0.43–1.17; p = 0.18)[11]
    • Febrile UTI: RR 1.19 (95% CI 0.91–1.56; p = 0.20)[11]
    • Length of stay: MD 0.76 days (p = 0.67)

The 2024 SSI trial does not support routine perioperative continuation until catheter or stent removal after open cystectomy; the 2025 postdischarge RCT addresses symptomatic UTI after robot-assisted surgery. Treatment of a documented infection is a separate indication with its own agent and duration.[2][10][25]

Patient- and procedure-level risk factors for SSI​

Grabe 2012 EAU tentative classification[15] describes useful domains of urologic SSI risk:

DomainRisk factors
Patient — generalHigher ASA, advanced age, malnutrition / hypoalbuminemia, obesity, uncontrolled hyperglycemia, smoking, immune dysfunction
Patient — urologicBacteriuria, indwelling catheter, stone disease, obstruction, prior urogenital infection
Procedure-relatedSurgical-field contamination class, operative duration, tissue handling / invasiveness, length of postoperative catheterization

The Seidelman 2023 JAMA SSI review[16] summarizes the cross-specialty evidence:

  • Administer within 60 minutes of incision
  • Cefazolin is the most commonly used agent; redose every 4 hours for lengthy procedures
  • A systematic review of 28 RCTs (n = 9,478) found no clear difference in surgical-site infection between single preoperative and multiple-dose prophylaxis (fixed-effect OR 1.06; 95% CI 0.89–1.25)[29]
  • Prolonged AP is increasingly associated with acute kidney injury and other harms
  • Stop antibiotics when the wound is closed

The Japanese 2015-edition guideline is a historical comparator.[18] The Japanese Urological Association 2023 edition, published in 2025, recommends cephamycin prophylaxis within 72 hours for cystectomy with gastrointestinal diversion . This differs in duration from the 2024 open-cystectomy trial, which found 24 hours noninferior to a median eight days for 90-day SSI.[10][26]

Administration and safety​

Use the adult table above with the local protocol. Start most agents within 60 minutes before incision; allow up to 120 minutes for vancomycin or fluoroquinolone administration. Vancomycin infusion duration depends on dose and infusion-rate limits. Redose short-half-life agents for long cases or substantial blood loss (about 1,500 mL); renal impairment may lengthen redosing intervals even when the initial prophylactic dose is unchanged.[2]

For most operations, stop prophylaxis at closure; the AUA BPS advises no postoperative doses even when a drain is in place.[1] A 24-hour cystectomy pathway has randomized support; a drain, catheter, or stent alone does not justify continuing prophylaxis. Active infection requires a separate treatment plan.[10][16][21]

Allergy history changes the choice​

The 2022 drug-allergy parameter permits cefazolin in most patients with penicillin allergy, including prior penicillin anaphylaxis, because its side chain is dissimilar. This does not establish safety after a cefazolin reaction, severe cutaneous adverse reaction (SJS/TEN, DRESS), or severe drug-related organ injury. Assess the culprit, reaction and timing; use allergy expertise for severe histories. Aztreonam shares a side chain with ceftazidime. Vancomycin infusion reactions and DRESS are different syndromes and require different management.[20]

Fluoroquinolone cautions​

Fluoroquinolones carry a boxed warning for disabling and potentially irreversible tendon, muscle, joint, peripheral-nerve and central nervous system reactions; the FDA advises reserving them for patients with no alternative in uncomplicated UTI, sinusitis and bronchitis.[23] Systemic fluoroquinolones carry warnings for blood-glucose disturbances, including severe hypoglycemia in patients receiving insulin or oral hypoglycemic agents, and for aortic aneurysm or dissection in susceptible patients.[32] A single perioperative dose is a different exposure from a treatment course, but prefer an effective non-fluoroquinolone agent where susceptibility allows, and avoid them in patients with tendon disorders, aortic aneurysm or dissection risk, diabetes on hypoglycemics, or prior fluoroquinolone reaction. In the EU, fluoroquinolone prophylaxis for prostate biopsy and other perioperative use is suspended.[19][23]

Renal function, pregnancy and monitoring​

Avoid unnecessary nephrotoxic combinations and distinguish a prophylactic dose from a therapeutic course. Serious MRSA treatment uses AUC-guided vancomycin monitoring (target AUC/MIC 400–600, assuming MIC 1 mg/L); an old trough-only target of 15–20 mg/L is not a prophylaxis protocol. Pregnancy requires agent- and gestation-specific selection with obstetric input.[22]

MRSA prevention​

Follow institutional screening or decolonization policy for selected procedures involving prosthetic material. A common carrier regimen uses intranasal mupirocin plus chlorhexidine body cleansing; the strongest evidence is from cardiac/orthopedic surgery, with extrapolation to other prosthetic procedures. For known MRSA colonization, a single preoperative vancomycin dose may be added to the procedure-specific prophylactic regimen.[2][21]

Evidence interpretation​

Guidelines contain recommendations of differing certainty; their publication does not make every statement “Level 1.” PUMP and national device cohorts are observational. NORAPP and the cystectomy-duration trial are randomized studies with defined populations and noninferiority margins. The Xiao Cochrane protocol has no completed pooled outcome to apply. Use these distinctions when adapting a local pathway.

See Also​

References​

1. Lightner DJ, Wymer K, Sanchez J, Kavoussi L. Best practice statement on urologic procedures and antimicrobial prophylaxis. J Urol. 2020;203(2):351–356. doi:10.1097/JU.0000000000000509

2. Bratzler DW, Dellinger EP, Olsen KM, et al. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm. 2013;70(3):195–283. doi:10.2146/ajhp120568

3. Zeng S, Zhang Z, Bai Y, Sun Y, Xu C. Antimicrobial agents for preventing urinary tract infections in adults undergoing cystoscopy. Cochrane Database Syst Rev. 2019;2:CD012305. doi:10.1002/14651858.CD012305.pub2

4. Barham DW, Pyrgidis N, Gross MS, et al. AUA-recommended antibiotic prophylaxis for primary penile implantation results in a higher, not lower, risk for postoperative infection: a multicenter analysis. J Urol. 2023;209(2):399–409. doi:10.1097/JU.0000000000003071

5. Abou Chawareb E, Hammad MAM, Azad B, et al. Perioperative antimicrobial strategies in inflatable penile prosthesis surgery. J Urol. 2025;214(6):642–653. doi:10.1097/JU.0000000000004716

6. Dropkin BM, Chisholm LP, Dallmer JD, Johnsen NV, Milam DF, Kaufman MR. Penile prosthesis insertion in the era of antibiotic stewardship — are postoperative antibiotics necessary? J Urol. 2020;203(3):611–614. doi:10.1097/JU.0000000000000578

7. Nicolle LE, Gupta K, Bradley SF, et al. Clinical practice guideline for the management of asymptomatic bacteriuria: 2019 update by the Infectious Diseases Society of America. Clin Infect Dis. 2019;68(10):e83–e110. doi:10.1093/cid/ciy1121

8. Pilatz A, Dimitropoulos K, Veeratterapillay R, et al. Antibiotic prophylaxis for the prevention of infectious complications following prostate biopsy: a systematic review and meta-analysis. J Urol. 2020;204(2):224–230. doi:10.1097/JU.0000000000000814

9. Jacewicz M, Günzel K, Rud E, et al. Antibiotic prophylaxis versus no antibiotic prophylaxis in transperineal prostate biopsies (NORAPP): a randomised, open-label, non-inferiority trial. Lancet Infect Dis. 2022;22(10):1465–1471. doi:10.1016/S1473-3099(22)00373-5

10. Thurnheer MC, Schürmann A, Huber M, et al. Perioperative antibiotic prophylaxis duration in patients undergoing cystectomy with urinary diversion: a randomized clinical trial. JAMA Netw Open. 2024;7(10):e2439382. doi:10.1001/jamanetworkopen.2024.39382

11. Mohamed T, Bani Irshid BA, Elhashamy H, et al. Optimal duration of perioperative antibiotics in radical cystectomy and urinary diversion: a systematic review and meta-analysis. Langenbecks Arch Surg. 2026. doi:10.1007/s00423-025-03943-x

12. Brant A, Lewicki P, Punjani N, et al. Trends in antimicrobial prophylaxis for inflatable penile prosthesis surgery from a large national cohort. Urology. 2023;172:131–137. doi:10.1016/j.urology.2022.11.010

13. Sun HH, Callegari M, Zhou E, et al. Trends over 20 years of antimicrobial prophylaxis for artificial urinary sphincter surgery. Neurourol Urodyn. 2023;42(6):1421–1430. doi:10.1002/nau.25206

14. Kutchukian S, Gondran-Tellier B, Dinh A, et al. Asymptomatic bacteriuria and urological surgery: risk factor or not? Results from the national and multicenter TOCUS database. J Urol. 2024;212(3):461–469. doi:10.1097/JU.0000000000004047

15. Grabe M, Botto H, Cek M, et al. Preoperative assessment of the patient and risk factors for infectious complications and tentative classification of surgical field contamination of urological procedures. World J Urol. 2012;30(1):39–50. doi:10.1007/s00345-011-0722-z

16. Seidelman JL, Mantyh CR, Anderson DJ. Surgical site infection prevention: a review. JAMA. 2023;329(3):244–252. doi:10.1001/jama.2022.24075

17. Marino Sabo E, Stern JJ. Approach to antimicrobial prophylaxis for urology procedures in the era of increasing fluoroquinolone resistance. Ann Pharmacother. 2014;48(3):380–386. doi:10.1177/1060028013517661

18. Yamamoto S, Shigemura K, Kiyota H, et al. Essential Japanese guidelines for the prevention of perioperative infections in the urological field: 2015 edition. Int J Urol. 2016;23(10):814–824. doi:10.1111/iju.13161

19. European Association of Urology. EAU Guidelines on Urological Infections. 2026. Periprocedural prophylaxis and prostate biopsy recommendations. Full guideline.

20. Khan DA, Banerji A, Blumenthal KG, et al. Drug allergy: a 2022 practice parameter update. J Allergy Clin Immunol. 2022;150:1333–1393. doi:10.1016/j.jaci.2022.08.028.

21. Calderwood MS, Anderson DJ, Bratzler DW, et al. Strategies to prevent surgical site infections in acute-care hospitals: 2022 Update. Infect Control Hosp Epidemiol. 2023;44:695–720. doi:10.1017/ice.2023.67.

22. ASHP/IDSA/PIDS/SIDP. Therapeutic monitoring of vancomycin for serious MRSA infections: revised consensus guideline. 2020. Guideline.

23. U.S. Food and Drug Administration. FDA Drug Safety Communication: FDA updates warnings for oral and injectable fluoroquinolone antibiotics due to disabling side effects. 2016. FDA

24. Jackson D, Higgins E, Bracken J, Yandell PM, Shull B, Foster RT Sr. Antibiotic prophylaxis for urinary tract infection after midurethral sling: a randomized controlled trial. Female Pelvic Med Reconstr Surg. 2013;19(3):137-141. doi:10.1097/SPV.0b013e318285ba53

25. Hussein AA, Mahmood AW, Ahmad A, et al. "Do prophylactic antibiotics decrease the rate of urinary tract infections after robot-assisted radical cystectomy? A randomized controlled trial." J Urol. 2025;214(2):147–155. doi:10.1097/JU.0000000000004586

26. Shigemura K, Kamei J, Shigehara K, et al. "Essential Japanese guidelines for the prevention of perioperative infections in the urological field: 2023 edition." Int J Urol. 2025;32(6):621–632. doi:10.1111/iju.70026

27. European Association of Urology. EAU Guidelines on Urethral Strictures. 2026; section 10.2. Full guideline.

28. Allergan, Inc. BOTOX (onabotulinumtoxinA) full prescribing information. Revised November 2023; section 2.3. DailyMed label.

29. McDonald M, Grabsch E, Marshall C, Forbes A. "Single- versus multiple-dose antimicrobial prophylaxis for major surgery: a systematic review." Aust N Z J Surg. 1998;68(6):388–396. doi:10.1111/j.1445-2197.1998.tb04785.x

30. Harmanli O, Boyer RL, Metz S, Tunitsky E, Jones KA. "Double-blinded randomized trial of preoperative antibiotics in midurethral sling procedures and review of the literature." Int Urogynecol J. 2011;22(10):1249–1253. doi:10.1007/s00192-011-1500-6

31. European Association of Urology. EAU Guidelines on Muscle-invasive and Metastatic Bladder Cancer. 2026; section 6.7.5.d. Guideline.

32. ProPharma Distribution. Ciprofloxacin in dextrose (ciprofloxacin injection, solution): prescribing information. DailyMed; updated November 2025. Label.