What are the ASCO/IDSA guidelines for antimicrobial prophylaxis in neutropenic cancer patients?

Updated: Sep 16, 2018
  • Author: Alexandre Chan, PharmD, MPH, FCCP, BCPS (AQ-ID), BCOP; more...
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Answer

Answer

The ASCO/IDSA guideline recommendations for antimicrobial prophylaxis are as follows [1] :

  • Risk of febrile neutropenia should be systematically assessed, with consideration of patient-related, cancer-related, and treatment-related factors (evidence-based; evidence quality: intermediate; strength of recommendation: strong).

  • Antibiotic prophylaxis with a fluoroquinolone is recommended for patients who are at high risk for febrile neutropenia or profound, protracted neutropenia (eg, most patients with acute myeloid leukemia/myelodysplastic syndromes or hematopoietic stem-cell transplantation [HSCT] treated with myeloablative conditioning regimens) (evidence-based; evidence quality: high; strength of recommendation: moderate).

  • Antibiotic prophylaxis is not routinely recommended for patients with solid tumors (evidence-based; evidence quality: high; strength of recommendation: moderate).

  • Antifungal prophylaxis with an oral triazole or parenteral echinocandin is recommended for patients who are at risk for profound, protracted neutropenia, such as most patients with acute myeloid leukemia/myelodysplastic syndromes  or HSCT. Antifungal prophylaxis is not routinely recommended for patients with solid tumors. Additional distinctions between recommendations for invasive candidiasis and invasive mold infection are provided within the full text of the guideline (evidence-based; evidence quality: intermediate; strength of recommendation: moderate).

  • Prophylaxis (eg, with trimethoprim-sulfamethoxazole [TMP-SMX]) is recommended for patients receiving chemotherapy regimens associated with > 3.5% risk for Pneumocystis jirovecii pneumonia (eg, those with ≥ 20 mg prednisone equivalents daily for ≥ 1 month or those receiving purine analogs) (evidence-based; evidence quality: high; strength of recommendation: strong).

  • Herpes simplex virus–seropositive patients undergoing allogeneic HSCT or leukemia induction therapy should receive prophylaxis with a nucleoside analog (eg, acyclovir) (evidence-based; evidence quality: high; strength of recommendation: strong).

  • Treatment with a nucleoside reverse transcription inhibitor (eg, entecavir or tenofovir) is recommended for patients who are at high risk of hepatitis B virus reactivation (consensus based; evidence quality: intermediate; strength of recommendation: moderate.)

  • Yearly influenza vaccination with inactivated vaccine is recommended for all patients receiving chemotherapy for malignancy and all family and household contacts and health care providers (consensus based; evidence quality: intermediate; strength of recommendation: moderate.)

  • The Expert Panel also supports other vaccination recommendations for immunosuppressed adult oncology patients that are contained in the IDSA guideline for vaccination of the immunosuppressed host [3]  (consensus based; evidence quality: intermediate; strength of recommendation: moderate).


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