Ciprofloxacin-associated acute renal failure in patients undergoing high-dose chemotherapy and autologous stem cell rescue

Abstract

Summary:The broad spectrum of activity of ciprofloxacin makes it an ideal drug for the prophylaxis of bacterial infections in patients undergoing high-dose chemotherapy (HDC) with autologous stem cell rescue. We present two cases of ciprofloxacin-associated acute renal failure (ARF) in patients undergoing HDC. Maintaining a high index of suspicion for this complication will allow a prompt diagnosis, with discontinuation of the drug usually resulting in a reversal of renal failure. Renal biopsy usually reveals changes compatible with interstitial nephritis, but is not always possible in these patients due to severe thrombocytopenia following HDC. A brief course of steroid therapy may be beneficial although the role of glucocorticoids is difficult to ascertain in the absence of data regarding its efficiency in this clinical setting. Keywords: ciprofloxacin; nephrotoxicity; high-dose chemotherapy; stem cell transplantation Prophylactic antibiotics following high-dose chemotherapy (HDC) have become routine, decreasing febrile episodes and greatly reducing the mortality from bacterial infections, primarily gram-negative sepsis. 1 The use of prophylactic oral ciprofloxacin has greatly facilitated the outpatient management of patients undergoing HDC. We report two cases of ciproloxacin-associated nephrotoxicity in patients undergoing HDC. Case reports Case 1A 53-year-old man with breast cancer was treated with HDC (cyclophosphamide 6000 mg/m 2 , etoposide 1500 mg/m 2 and carboplatin 1200 mg/m 2 ). Prophylactic oral ciprofloxacin 750 mg and rifampin 300 mg twice daily, and acyclovir 400 mg three times a day were started on the day of stem cell reinfusion. On day 8 he developed febrile neutropenia and was hospitalized. Vancomycin 30 mg/kg/day and ceftriaxone 2 g/day intravenously were added and ciprofloxacin was continued. Rifampin was stopped. All cultures were negative. Clinically, the patient was not septic, hypovolemic or dehydrated and had good urine output. On admission his creatinine was 1.5 mg/dl, and increased to 4.8 mg/dl the following day. Urinalysis revealed few white blood cells and no eosinophils. Renal ultrasound showed neither obstruction nor hydroephrosis. Ciprofloxacininduced nephritis was diagnosed; all antibiotics were discontinued, and intravenous solumedrol 120 mg/day was started. The creatinine peaked the following day to 6.0 mg/dl, and returned to normal on the third day. Case 2A 56-year-old woman with multiple myeloma underwent HDC with melphalan 140 mg/m 2 . Prophylactic oral ciprofloxacin 750 mg and rifampin 300 twice daily were begun on the day of stem cell reinfusion. Her creatinine was 0.6 mg/dl. On day 9 she developed a fever and was begun on intravenous vancomycin 30 mg/kg/day and ceftriaxone 2 g/day, with continuation of ciprofloxacin. Rifampin was discontinued. All cultures were negative. The following day the creatinine rose to 3.3 mg/dl and she developed oliguria without hypotension or hypovolemia. She had received only one dose of vancomycin and ceftriaxone. Urinalysis showed few whit...

Fluoroquinolone-induced serious, persistent, multisymptom adverse effects

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Acute renal failure requiring dialysis after allogeneic blood and marrow transplantation identifies very poor prognosis patients

“…10,11 Risk factors after autologous BMT include interstitial nephritis due to ciprofloxacin use. 12 However, there is little information available on the prognosis of patients who develop renal failure requiring dialysis. In this study, we analyzed the incidence, risk factors and associated mortality of acute renal failure requiring dialysis in a cohort of alloBMT patients.…”

Administration of BMSCs with Muscone in Rats with Gentamicin-Induced AKI Improves Their Therapeutic Efficacy

“…In the treatment of AKI, the therapeutic actions of stem cells in preventing and repairing damaged renal cells have been demonstrated by previous studies [13]–[15]. Different types of stem cells, such as amniotic fluid stem cells [16], hematopoietic progenitor cells [17], and kidney-derived mesenchymal stem cells[18], have been investigated, and their therapeutic effects in AKI treatment have been determined.…”