Prophylactic antibiotic with ofloxacin (OFLO) may significantly decrease the one-year incidence of urinary tract infections (UTIs) and acute pyelonephritis (APN) in renal transplant recipients, according to French researchers.

Alexandre Hertig, MD, of Urgence Néphrologique et Transplantation Rénale, Hôpital Tenon, Paris, and colleagues conducted a prospective study in which they were able to test the prophylactic use of OFLO as a means of preventing UTIs and other infections in renal transplant recipients during an outbreak of Legionnaire’s disease.  As a result of a Legionella pneumophila contamination of the hospital’s water pipes, the hospital instituted a new protocol in which the usual prophylactic antibiotic, trimethoprim-sulfamethoxazole (TMP-SMX), was reinforced with OFLO 200 mg every other day.

The investigators measured the incidence of UTI and APN in 100 consecutive patients divided into two groups: 50 patients treated with TMP-SMX alone prior to the introduction of the new protocol and 50 treated with both TMP-SMX and OFLO under the new protocol. They also examined resistance profiles in their own department and the rest of the hospital.

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Dr. Hertig’s group, which published their findings in Transplant Infectious Disease (2011:1388- 2273), identified no case of Legionnaire’s disease, but they observed a 63% decreased incidence of UTIs and a 71% decreased incidence in the patients receiving the OFLO regimen. The protection was sustained during the entire first year post-transplantation.

In terms of resistance rates, the researchers observed a decrease in the susceptibility of Pseudomonas aerguinosa to ciprofloxacin in the nephrology department compared with the rest of the hospital. Overall, the incidence of multidrug-resistant bacteria was stable, but the investigators cautioned that emergence of resistant strains is a major concern and a thorough and prolonged monitoring of bacterial susceptibility is warranted to determine the safety of this type of prophylaxis in renal transplant recipients.

“While we cannot recommend this therapy in routine practice today, our findings suggest that, in addition to minimizing the duration of ureteral stenting, regimens of reinforced prophylactic antibiotherapy in high-risk patients could be effective in reducing the incidence of both UTI and APN,” the authors wrote.