Eur Urol

Single-dose ciprofloxacin modestly reduces pyelonephritis after shockwave lithotripsy

October 15, 2025

While the absolute reduction in infection risk was modest, ciprofloxacin prophylaxis may be considered for patients at higher risk of post-shockwave lithotripsy (SWL) complications. These findings support individualized antibiotic use and contribute to evidence-based global practice amid ongoing concerns about antimicrobial resistance.

Study details: The international, multicenter, double-blind randomized APPEAL trial enrolled adults undergoing SWL for urolithiasis. Participants were randomized to receive a single pre-procedural dose of ciprofloxacin or placebo. Primary outcome: composite of post-SWL bacteriuria or symptomatic UTI; secondary outcomes: pyelonephritis and urosepsis.

Results: Among 1,694 participants (median age, 50 years; 30% female), 74% had renal calculi and 26% had ureteral stones. Incidence of bacteriuria or symptomatic UTI within 14 days post-SWL was lower in the ciprofloxacin group (2.7%) compared with placebo (3.9%), though the difference wasn't statistically significant (risk ratio [RR], 0.68; 95% confidence interval [CI], 0.41–1.15). Rates of symptomatic UTI were 1.3% with ciprofloxacin vs. 2.7% with placebo (RR, 0.49; 95% CI, 0.19–1.23). Importantly, no cases of pyelonephritis occurred in the ciprofloxacin group, while 1.2% of placebo recipients developed pyelonephritis (RR, 0.05; 95% CI, 0.003–0.93). No urosepsis or serious adverse events were reported in either group.

Source:

Tikkinen KAO, et al; APPEAL Trial Investigators. (2025, September 24). Eur Urol. A Multicenter Randomized Controlled Trial of Antimicrobial Prophylaxis to Prevent Urinary Tract Infections after Shockwave Lithotripsy for Urolithiasis: The APPEAL Trial. https://pubmed.ncbi.nlm.nih.gov/40998628/