Title

Randomized trial of prophylactic antibiotics vs. placebo after midshaft-to-distal hypospadias repair: The PROPHY Study

Authors

Mark A. Faasse, Advocate Aurora HealthFollow
Walid A. Farhat, University of Wisconsin-Madison, Madison, WI, USA.
Ilina Rosoklija, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
Rachel Shannon, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
Rakan I. Odeh, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
Grace M. Yoshiba, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
Fadi Zu'bi, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
Lauren C. Balmert, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Dennis B. Liu, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA; Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Fahad A. Alyami, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
Jennifer L. Beaumont, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Daniel L. Erickson, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Edward M. Gong, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA; Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Emilie K. Johnson, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA; Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Sandra Judd, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
William E. Kaplan, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA; Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Gagan Kaushal, Thomas Jefferson University, Philadelphia, PA, USA.
Martin A. Koyle, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
Bruce W. Lindgren, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA; Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Max Maizels, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA; Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Charles R. Marcus, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
Kimberly L. McCarter, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
Theresa Meyer, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
Tarannum Qureshi, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
Megan Saunders, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
Theresa Thompson, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
Elizabeth B. Yerkes, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA; Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Earl Y. Cheng, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA; Northwestern University Feinberg School of Medicine, Chicago, IL, USA.

Affiliations

Advocate Children's Hospital

Abstract

Background: Use of prophylactic antibiotics after stented hypospadias repair is very common, but most research has not identified any clinical benefits of this practice. Only one study has found that postoperative prophylaxis reduces symptomatic urinary tract infections (UTIs). Data from the same trial suggested that prophylaxis may also reduce urethroplasty complications. No studies on this subject have been placebo-controlled.

Objective: We performed a randomized, double-blind, placebo-controlled study to evaluate the effect of postoperative prophylactic antibiotics on the incidence of infection or urethroplasty complications after stented repair of midshaft-to-distal hypospadias.

Study design: Boys were eligible for this multicenter trial if they had a primary, single-stage repair of mid-to-distal hypospadias with placement of an open-drainage urethral stent for an intended duration of 5-10 days. Participants were randomized in a double-blind fashion to receive oral trimethoprim-sulfamethoxazole or placebo twice daily for 10 days postoperatively. The primary outcome was a composite of symptomatic UTI, surgical site infection (SSI), and urethroplasty complications, including urethrocutaneous fistula, meatal stenosis, and dehiscence. Secondary outcomes included each component of the primary outcome as well as acute adverse drug reactions (ADRs) and C. difficile colitis.

Results: Infection or urethroplasty complications occurred in 10 of 45 boys (22%) assigned to receive antibiotic prophylaxis as compared with 5 of 48 (10%) who received placebo (relative risk [RR], 2.1; 95% confidence interval [CI], 0.8 to 5.8; p = 0.16). There were no significant differences between groups in symptomatic UTIs, SSIs, or any urethroplasty complications. Mild ADRs occurred in 3 of 45 boys (7%) assigned to antibiotics as compared with 5 of 48 (10%) given placebo (RR, 0.6; 95% CI, 0.2 to 2.5; p = 0.72). There were no moderate-to-severe ADRs, and no patients developed C. difficile colitis.

Conclusions: In this placebo-controlled trial of 93 patients, prophylactic antibiotics were not found to reduce infection or urethroplasty complications after stented mid-to-distal hypospadias repair. The study did not reach its desired sample size and was therefore underpowered to independently support a conclusion that prophylaxis is not beneficial. However, the result is consistent with most prior research on this subject. CLINICALTRIALS.

Document Type

Article

PubMed ID

35144885


 

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