Ciprofloxacin decreased polyoma BK virus load in patients who underwent allogeneic hematopoietic stem cell transplantation

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, 3 x 10(5) copies/mL vs. 2.6 x 10(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 greater than or equal to3-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 greater than or equal to3-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 mug/mL (range, 23.0 - 152.9 mg/mL), which was comparable with the in vitro inhibitory concentration of 125 - 250 mg/ mL of ciprofloxacin found for 3 of 7 BKV isolates. Conclusions. Ciprofloxacin decreased urinary BKV reactivation after HSCT.