title: Ciprofloxacin decreased polyoma BK virus load in patients who underwent allogeneic hematopoietic stem cell transplantation.
abstract: BACKGROUND
  Polyoma BK virus (BKV) is associated with hemorrhagic cystitis during hematopoietic stem cell transplantation (HSCT). The objective of this study was to test whether standard-dose ciprofloxacin might suppress reactivation of BKV infection during HSCT.
  
  
  METHODS
  Sixty-eight patients received ciprofloxacin or a cephalosporin as antibiotic prophylaxis after undergoing allogeneic HSCT. Urine samples were collected weekly from day 7 before HSCT to day 50 after HSCT. Laboratory investigations included quantification of BKV load and urinary ciprofloxacin levels and in vitro drug sensitivity of BKV.
  
  
  RESULTS
  Twenty-two patients received ciprofloxacin, 21 received cephalosporins, 12 received concomitant corticosteroids and antibiotics (9 received ciprofloxacin, and 3 received cephalosporins), and 13 received interrupted ciprofloxacin therapy. Ciprofloxacin recipients developed a significantly lower peak BKV load, compared with cephalosporin recipients (median, 3x10(5) copies/mL vs. 2.6x10(9) copies/mL; P=.021), irrespective of concomitant receipt of corticosteroid therapy. Fewer ciprofloxacin recipients than cephalosporin recipients (P=.013) developed BKV viruria with a > or =3-log increase in BKV load during HSCT, which was associated with significantly more cases of hemorrhagic cystitis (8 of 29 patients with a peak increase of > or =3 log vs. 0 of 39 patients without a peak increase of this level; P<.001). Ciprofloxacin recipients excreted ciprofloxacin in urine at a mean 24-h rate of 71.7 microg/mL (range, 23.0-152.9 microg/mL), which was comparable with the in vitro inhibitory concentration of 125-250 microg/mL of ciprofloxacin found for 3 of 7 BKV isolates.
  
  
  CONCLUSIONS
  Ciprofloxacin decreased urinary BKV reactivation after HSCT.
authors.affiliation: Department of Medicine, University of Hong Kong, China.
authors.forename: Anskar Y H
authors.initials: AY
authors.lastname: Leung
authors.forename: Maggie T L
authors.initials: MT
authors.lastname: Chan
authors.forename: Kwok-Yung
authors.initials: KY
authors.lastname: Yuen
authors.forename: Vincent C C
authors.initials: VC
authors.lastname: Cheng
authors.forename: Kwok-Hung
authors.initials: KH
authors.lastname: Chan
authors.forename: Chris L P
authors.initials: CL
authors.lastname: Wong
authors.forename: Raymond
authors.initials: R
authors.lastname: Liang
authors.forename: Albert K W
authors.initials: AK
authors.lastname: Lie
authors.forename: Yok-Lam
authors.initials: YL
authors.lastname: Kwong
mesh_terms: D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis; D001739:BK Virus / Q000302:isolation & purification / Q000502:physiology; D002939:Ciprofloxacin / Q000494:pharmacology* / Q000627:therapeutic use; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D027601:Polyomavirus Infections / Q000517:prevention & control* / Q000821:virology; D014184:Transplantation, Homologous / Q000009:adverse effects*; D014412:Tumor Virus Infections / Q000517:prevention & control* / Q000821:virology; D014556:Urine / Q000821:virology; D019562:Viral Load; D014779:Virus Replication / Q000187:drug effects
chemical_list: D000900:Anti-Bacterial Agents; D002939:Ciprofloxacin