Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Commentary
  • Published:

Antibiotic prophylaxis in allogeneic stem cell transplantation—what is the correct choice?

Bone Marrow Transplantation volume 51, pages 1071–1072 (2016)Cite this article

Subjects

In this month’s issue, Weber et al.1 reported the results of a single-center retrospective study of two cohorts of patients receiving allogeneic stem cell transplantation (allo-SCT) treated with different prophylactic antibiotic regimens.

The potential of antibiotics to modulate outcomes after allo-SCT was first observed in mouse models2, 3 followed by clinical studies.4, 5 In both types of studies, intestinal bacteria were found to contribute to acute GvHD, and total decontamination led to a benefit. Subsequent clinical studies, however, did not consistently demonstrate a reduction in GvHD from antibiotics, possibly due to unreliable total decontamination.6 Total gut decontamination is now routinely attempted at only a small minority of transplant centers and has been largely supplanted by fluoroquinolone-based prophylaxis. Ciprofloxacin and levofloxacin are both commonly used based on many studies of neutropenic patients with cancer, where fluoroquinolone use prevented febrile events and bloodstream infections, and a meta-analysis was associated with a reduction in all-cause mortality.7

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

References

  1. Weber D, Oefner PJ, Dettmer K, Hiergeist A, Koestler J, Gessner A et al. Rifaximin preserves intestinal microbiota balance in patients undergoing allogeneic stem cell transplantation. Bone Marrow Transplant, (e-pub ahead of print 21 March 2016 doi:10.1038/bmt.2016.66.

    Article  CAS  PubMed  Google Scholar 

  2. Jones JM, Wilson R, Bealmear PM . Mortality and gross pathology of secondary disease in germfree mouse radiation chimeras. Radiat Res 1971; 45: 577–588.

    Article  CAS  PubMed  Google Scholar 

  3. van Bekkum DW, Roodenburg J, Heidt PJ, van der Waaij D . Mitigation of secondary disease of allogeneic mouse radiation chimeras by modification of the intestinal microflora. J Natl Cancer Inst 1974; 52: 401–404.

    Article  CAS  PubMed  Google Scholar 

  4. Storb R, Prentice RL, Buckner CD, Clift RA, Appelbaum F, Deeg J et al. Graft-versus-host disease and survival in patients with aplastic anemia treated by marrow grafts from HLA-identical siblings. Beneficial effect of a protective environment. N Engl J Med 1983; 308: 302–307.

    Article  CAS  PubMed  Google Scholar 

  5. Vossen JM, Heidt PJ, van den Berg H, Gerritsen EJ, Hermans J, Dooren LJ . Prevention of infection and graft-versus-host disease by suppression of intestinal microflora in children treated with allogeneic bone marrow transplantation. Eur J Clin Microbiol Infect Dis 1990; 9: 14–23.

    Article  CAS  PubMed  Google Scholar 

  6. Vossen JM, Guiot HF, Lankester AC, Vossen AC, Bredius RG, Wolterbeek R et al. Complete suppression of the gut microbiome prevents acute graft-versus-host disease following allogeneic bone marrow transplantation. PLoS ONE 2014; 9: e105706.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Freifeld AG, Bow EJ, Sepkowitz KA, Boeckh MJ, Ito JI, Mullen CA et al. Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the infectious diseases society of america. Clin Infect Dis 2011; 52: e56–e93.

    Article  PubMed  Google Scholar 

  8. Beelen DW, Elmaagacli A, Muller KD, Hirche H, Schaefer UW . Influence of intestinal bacterial decontamination using metronidazole and ciprofloxacin or ciprofloxacin alone on the development of acute graft-versus-host disease after marrow transplantation in patients with hematologic malignancies: final results and long-term follow-up of an open-label prospective randomized trial. Blood 1999; 93: 3267–3275.

    CAS  PubMed  Google Scholar 

  9. Taur Y, Xavier JB, Lipuma L, Ubeda C, Goldberg J, Gobourne A et al. Intestinal domination and the risk of bacteremia in patients undergoing allogeneic hematopoietic stem cell transplantation. Clin Infect Dis 2012; 55: 905–914.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Taur Y, Jenq RR, Perales MA, Littmann ER, Morjaria S, Ling L et al. The effects of intestinal tract bacterial diversity on mortality following allogeneic hematopoietic stem cell transplantation. Blood 2014; 124: 1174–1182.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Holler E, Butzhammer P, Schmid K, Hundsrucker C, Koestler J, Peter K et al. Metagenomic analysis of the stool microbiome in patients receiving allogeneic stem cell transplantation: loss of diversity is associated with use of systemic antibiotics and more pronounced in gastrointestinal graft-versus-host disease. Biol Blood Marrow Transplant 2014; 20: 640–645.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Jenq RR, Taur Y, Devlin SM, Ponce DM, Goldberg JD, Ahr KF et al. Intestinal blautia is associated with reduced death from graft-versus-host disease. Biol Blood Marrow Transplant 2015; 21: 1373–1383.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Gillis JC, Brogden RN . Rifaximin. A review of its antibacterial activity, pharmacokinetic properties and therapeutic potential in conditions mediated by gastrointestinal bacteria. Drugs 1995; 49: 467–484.

    Article  CAS  PubMed  Google Scholar 

  14. Lopetuso LR, Petito V, Scaldaferri F, Gasbarrini A . Gut microbiota modulation and mucosal immunity: focus on rifaximin. Mini Rev Med Chem 2015; 16: 179–185.

    Article  PubMed  Google Scholar 

  15. Bajaj JS, Heuman DM, Sanyal AJ, Hylemon PB, Sterling RK, Stravitz RT et al. Modulation of the metabiome by rifaximin in patients with cirrhosis and minimal hepatic encephalopathy. PLoS ONE 2013; 8: e60042.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Medicine, Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    R R Jenq & M R M van den Brink

  2. Department of Medicine, Weill Cornell Medical College, New York, NY, USA

    R R Jenq & M R M van den Brink

  3. Department of Immunology, Sloan Kettering Institute for Cancer Research, New York, NY, USA

    M R M van den Brink

Authors
  1. R R Jenq
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M R M van den Brink
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M R M van den Brink.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Jenq, R., van den Brink, M. Antibiotic prophylaxis in allogeneic stem cell transplantation—what is the correct choice?. Bone Marrow Transplant 51, 1071–1072 (2016). https://doi.org/10.1038/bmt.2016.144

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/bmt.2016.144

Search

Advanced search

Quick links