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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

This book summarizes and brings up-to-date practically all our knowledge concerning antimicrobial prophylaxis in urology. Because of the profound effect the new fluoroquinolones have had in urology, their use is particularly emphasized and critically evaluated. In the first part, general considerations of antimicrobial prophylaxis and their specific problems in urology are provided. This includes a cost-benefit analysis of antimicrobial prophylaxis. The second and third part summarizes results of laboratory and animal studies. The fourth part includes human studies and an extensive review of the pertinent literature. For the first time summarized in one book, specific guidelines for each urologic procedure are provided, based on these theoretical, experimental and clinical considerations. This book primarily addresses the urologist; but also infectious disease specialists and hospital epidemiologists can derive new and relevant information from it.

Antimicrobial agents are essential for the treatment of life-threatening infections and for managing the burden of minor infections in the community. In addition, they play a key role in organ and bone marrow transplantation, cancer chemotherapy, artificial joint and heart valve surgery. Unlike other classes of medicines, they are vulnerable to resistance from mutations in target microorganisms, and their adverse effects may extend to other patients (increased risk of cross-infection). As a consequence, there is a constant requirement for new agents, as well as practices that ensure the continued effective prescribing of licensed agents. Public awareness and concerns about drug resistant organisms has led to widespread publicity and political action in the UK, Europe and worldwide. The control of drug resistance and the implementation of good prescribing practice are now legal requirements in the UK as a result of the UK Health Act (2008). These fundamental changes underscore the need for a thorough understanding of the advantages and risks associated with specific antibiotic choices. This sixth edition of Antimicrobial Chemotherapy continues to be a valuable resource for undergraduates and graduates requiring a thorough grounding in the scientific basis and clinical application of these drugs. This new edition is updated to include the most recently licensed agents, notably in the treatment of viral infections including HIV/AIDS, and contains new guidance on prescribing practice and infection control practices that limit the development and spread of resistant organisms.