THE IMPACT OF PROPHYLACTIC CIPROFLOXACIN ON INFECTIVE OR FEBRILE
EPISODES IN PATIENTS UNDERGOING AUTOLOGOUS STEM CELL TRANSPLANT
Emma Crocombe, Julie Blundell and Adewale Adeyemo. Department of Pharmacy and
Haematology, Royal Cornwall Hospital, Truro.
Introduction Bacterial infections are a major cause of morbidity and mortality in patients
following autologous stem cell transplant. Antibiotic prophylaxis started at the time of
chemotherapy may reduce infection-related mortality, febrile episodes and bacteraemia1,2. In
our hospital oral ciprofloxacin is used for prophylaxis in myeloma and lymphoma patients
post-autologous stem cell transplant. This antibiotic has been associated with selecting
resistant organisms; with Clostridium difficile-associated diarrhoea (CDAD) and has been
linked to the rising incidence of methicillin-resistant Staphylococcus aureus (MRSA)
infections3,4. Furthermore it has been our impression that many patients still require
intravenous antibiotics.
Aim To determine whether the administration of prophylactic ciprofloxacin had any effect on
subsequent infective or febrile episodes in patients following autologous stem-cell transplant.
Method We did a retrospective study of the last 22 patients undergoing autologous stem-cell
transplant in our hospital. We reviewed hospital notes and drug charts to establish the
duration of ciprofloxacin therapy and whether patients required intravenous antibiotics. We
checked microbiology results for positive blood cultures and antibiotic sensitivities of
isolates.
Results Twenty of the twenty-two patients became pyrexial and alternative intravenous
antibiotics were started. Two patients remained on ciprofloxacin and did not require any
other antibiotics. There were eleven positive blood cultures: nine coagulase negative
staphylococci, one methicillin-resistant Staphylococcus, and one Stenotrophomonas spp. Five
of the isolates were resistant to ciprofloxacin. One patient developed CDAD.
Conclusion This study suggests ciprofloxacin prophylaxis may not reduce the number of
febrile incidents. It does not prevent coagulase negative staphylococcal bacteraemia and
resistant strains, including MRSA may be selected. There may be a lower incidence of gramnegative sepsis but resistant strains may be a problem. We may now reconsider our policy of
routine ciprofloxacin prophylaxis in this patient group.
REFERENCES
1. Gafter-Gvili A, Fraser A, Paul M and Leibovici L. Meta-analysis: Antibiotic prophylaxis reduces mortality in neutropenic
patients. Ann Intern Med 2005; 142: 979-995.
2. Krupova Y, Novotny J, Sabo A, Mateicka F and Krcmery V. Aetiology, cost of antimicrobial therapy and outcome in
neutropenic patients who developed bacteraemia during antimicrobial prophylaxis: a case-control study. Int J Antimicrob Agents
1998; 10: 313-316.
3. Gafter-Gvili A, Paul M, Fraser A and Leibovici L. Effect of quinolone prophylaxis in afebrile neutropenic patients on
microbial resistance: systematic review and meta-analysis. J Antimicrob Chemother 2007; 59: 5-22.
4. ME, Harris AD, Perencevich E, Roghmann M-C. Fluoroquinolone use and Clostridium difficile-associated diarrhea. Emerg
Infect Dis 2003; 9(6). Available from: URL: http://www.cdc.gov/ncidod/EID/vol9no6/02-0385.htm
THE IMPACT OF PROPHYLACTIC CIPROFLOXACIN ON INFECTIVE OR
FEBRILE EPISODES IN PATIENTS UNDERGOING AUTOLOGOUS STEM
CELL TRANSPLANT
Emma Crocombe, Julie Blundell and Adewale Adeyemo. Department of Pharmacy and
Haematology, Royal Cornwall Hospital, Truro.
Emma Crocombe
Pharmacy Department
Royal Cornwall Hospital
Truro
TR1 3LJ
Telephone: 01872 252984
Fax: 01872 223438
Email: emma.crocombe@rcht.cornwall.nhs.uk