Despite universal agreement on the application of antimicrobial prophylaxis, the optimum administration period of antibiotics for percutaneous nephrolithotomy (PCNL) remains controversial and the risk for antimicrobial resistance due to prolonged antibiotic use as well as financial burden that may prove to be challenging for both the patient and the physician. This study therefore aims to determine the safety and effectiveness of a single dose antibiotic prophylaxis in patients undergoing PCNL.

A randomized controlled trial was conducted in PCNL patients between 2021-2023. The patients were randomly assigned to three groups: single dose prophylaxis 30 minutes before surgery arm (Group A), 30 minutes before and 12 hours after surgery arm (Group B), and continued antibiotics until removal of nephrostomy tube arm (Group C), respectively.

A total of 81 patients were included (Group A=27, Group B=28, and Group C=26). The rate of comorbidities did not differ significantly in the three groups: HTN (p=0.166), DM (p=0.121), and Others (p=0.405). The presence of hydronephrosis was seen in 70.4% of patients. About half had solitary stone type (54.3%) and had left area affected (51.8%). Also, 14.8% had history of UTI. The patient groups did not differ in clinical and operative characteristics (all p > 0.05) except in history of previous stone surgeries. Significantly more patients had previous history of stone surgeries in Group A (37.0%) than in Group B (3.6%) and Group C (15.4%) (p=0.006). The following proportion of no growth in preoperative urine culture was observed: Group A (92.6%), Group B (89.3%), and Group C (80.8%) (p=0.174). The estimated blood loss was significantly lower in Group A (130.7ml) than in Group B (235.7ml) and Group C (261.5ml) (p=0.032). Significantly less patients in Group A were free from stone (74.1%) compared to Group B (92.9%) and Group C (96.2%) (p=0.030). After surgery, only two patients (2.5%) had criteria consistent with SIRS and both belonged in Group C. No significant difference in incidence of SIRS was observed among the three groups (p=0.067).

Single dose antibiotic prophylaxis for the prevention of post-operative bacterial infection in patients undergoing PCNL is as effective as multiple dose antibiotic prophylaxis. Consistent with existing guidelines on PCNL, single dose antibiotic prophylaxis is highly recommended as it is more cost-effective and may lower the risk for antibiotic resistance in the future. More RCTs with larger sample size which can determine the effectiveness of single dose antibiotic prophylaxis in patients at high-risk for post-operative PCNL infections are recommended.