Oral ciprofloxacin as antibacterial prophylaxis after allogeneic bone marrow transplantation: a reappraisal

The efficacy of ciprofloxacin as antibacterial prophylaxis for allogeneic b one marrow transplantation has been well documented, and it virtually elimi nated bacteremias caused by gram-negative pathogens in early reports, Cipro floxacin was therefore incorporated into the prophylactic antibiotic regime n during allogeneic bone marrow or peripheral blood stem cell transplantati on at Veterans General Hospital, Kaohsiung from February 1997. In 12 consec utive patients receiving allogeneic bone marrow or peripheral blood stem ce ll transplantation, ciprofloxacin-resistant Escherichia coli bacteremia dev eloped in three (25%). In addition to our data, increasing evidence suggest s that the widespread use of a fluoroquinolone is associated with the emerg ence of resistant isolates as well as documented infections caused by these resistant strains. The incidence of Escherichia coli bacteremia in our tra nsplant patients was 25%, which was similar to that in patients not receivi ng preventive therapy or in those receiving trimethoprim-sulfamethoxazole p rophylaxis. The prophylactic efficacy of ciprofloxacin in allogeneic bone m arrow transplant or peripheral blood stem cell transplant recipients should therefore be reassessed.