A next generation BCG vaccine moves forward

until now there has been no level 1 evidence to support Jacewicz and colleagues1 compared a single dose of prostate biopsy in patients without risk factors for infection (eg, recent urinary tract infection, indwelling outcome was incidence of an infection that required hospitalisation up to 2 months after the procedure, as assessed by patient-reported questionnaires. Clinical information was collected for patients reporting symptoms suggesting an infection. 555 (70%) of 792 patients referred for biopsy were included, and randomly allocated 1:1 to cefuroxime, given intramuscularly or intravenously 30 min before the biopsy, or no prophylaxis. All patients completed the post-biopsy questionnaires. The trial was conducted in The results confirm previously reported low rates of severe infectious complications after transperineal prostate biopsy: no patient was admitted to hospital for an infection after biopsy (with an upper 95% CI of 1??4%). Three patients in the non-prophylaxis group and one in the cefuroxime group reported a urinary tract infection not requiring hospitalisation (difference 0??7%, 95% CI ???1??1 to 2??8). The authors conclude that prophylactic antibiotics can safely be omitted in patients without risk factors for infection who undergo a transperineal prostate biopsy. Jacewicz and colleagues are to be complimented for designing and executing this randomised clinical trial. The question is, are their results sufficient for a recommendation to abstain from prescribing clinical practice, but as similarly low infectious