Ciprofloxacin recipients

Ciprofloxacin can be associated with partial or complete tendinitis. Of 72 lung transplant recipients who received ciprofloxacin, 20 had Achilles tendon involvement (tendinitis 15, rupture 5) (49). Tendon rupture occurred at a lower dosage of ciprofloxacin than tendinitis and the mean recovery duration was significantly longer. 

In 42 patients who had received a kidney transplant, cases were treated with ciprofloxacin in the first 1-6 months after transplantation, and matched controls (two per case) were not. The proportion of cases with at least one episode of biopsy-proven rejection 1-3 months after transplantation (45%) was significantly higher than in the controls (19%). The authors speculated that ciprofloxacin increases rejection rates in renal transplant recipients by antagonizing ciclosporin-dependent inhibition of interleukin-2 production (69). 

Chhajed PN, Plit ML, Hopkins PM, Malouf MA, Glanville AR. Achilles tendon disease in lung transplant recipients association with ciprofloxacin. Eur Respir J 2002 19(3) 469-71. 

Tendinopathy and partial or complete tendon rupture as adverse events of fluoroquinolones have been reported during or shortly after the use of fluoroquinolones (80-84). Pefloxacin and ofloxacin have been implicated, as has ciprofloxacin (85,86). In six patients taking fluoroquinolones risk factors included renal insufficiency, glucocorticoid therapy, secondary hyperparathyroidism, advanced age, and diabetes mellitus (87). Cases have also been reported among immunocompromised renal transplant recipients (88). 

A 66-year-old kidney transplant recipient developed a gangrenous lesion on the left foot infected with S. aureus and Escherichia coli. He was given ciprofloxacin and chndamycin for 6 weeks and then fusidic acid 1500 mg/day for 2 weeks. He became Ul, with myalgia and no active movement of his legs, and rhabdomyolysis was established by laboratory tests. He had also taken atorvastatin 10 mg/day and he slowly recovered after withdrawal of both atorvastatin and fusidic acid. 

Prostatitis due to vancomycin-resistant enterococci has been reported in a 42-year-old liver transplant recipient (84). The organism. Enterococcus faecium, was resistant to vancomycin, ampicillin, ciprofloxacin, and doxycycline. Treatment with a combination of rifampicin and nitrofurantoin for 6 weeks resulted in a long-lasting cure. 

Rosado LJ, Siskind MS, Copeland JG. Acute interstitial nephritis in a cardiac transplant recipient receiving ciprofloxacin. The Journal of thoracic and cardiovascular surgery. 1994 May 107(5) 1364 author reply -6. 

Kruger HU, Schuler U, Proksch B, Gobel M, Ehninger G. Investigation of potential interaction of ciprofloxacin with cyclosporine in bone marrow transplant recipients. Antimicrobial agents and chemotherapy. 1990 Jun 34(6) l 048-52. 

Rosado LJ, Siskind MS, Nolan PE, Copeland JG. Invit letter concemii acute interstitial nephritis in a cardiac tran lant recipients receiving ciprofloxacin. J Thorac Cardiovasc Surg (1994) 107,1365-6. 

An oral ulcer occurred in a renal transplant recipient who took sirolimus for 6 days [129 ]. Culture of the fibrin plaque of the ulcer yielded Cedecea davisae, a Gramnegative bacillus, which was treated successfully with ciprofloxacin. Sirolimus was withdrawn and the oral mucosa completely healed in 5 weeks. Most sirolimus-associated ulcers occur when the sirolimus serum concentration is over 7 pg/l this patient s sirolimus concentration was 4.9 pg/l. 

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