PROPHYLAXIS GUIDELINES FOR THE ADULT …

MD S

Indication

Receiving chemotherapy

APL Induction

AML Intensive Induction

PROPHYLAXIS GUIDELINES FOR THE ADULT HEMATOLOGY PATIENT

Antibacterial

Antifungal

No routine prophylaxis

Fluconazole 200 mg PO daily

No routine prophylaxis

If differentiating on steroids: Levofloxacin 500 mg PO daily

No routine prophylaxis

Micafungin 100 mg IV q24h

Voriconazole 200 mg PO BID (trough level after 5-7 days)

PJP prophylaxis

No routine prophylaxis

Antiviral

Acyclovir 400 mg PO BID

Duration of Prophylaxis

Antifungal: Beginning when ANC 500 and continuing throughout neutropenia

Antiviral: Throughout all chemotherapy cycles

No routine prophylaxis

Acyclovir 400 mg PO BID

AML

AL L

HMA + Venetoclax Relapsed/Refractory or >70 years Induction Consolidation ALL Induction Beyond Induction

Blinatumomab Inotuzumab

Hairy Cell Leukemia

Aplastic Anemia

Levofloxacin 500 mg PO daily Levofloxacin 500 mg PO daily Levofloxacin 500 mg PO daily

Posaconazole 300 mg tab PO daily

For relapsed/refractory patients unlikely to recover ANC:

Posaconazole 300 mg tab PO daily

For patients receiving purine analogue1:

TMP-SMX (Bactrim) DS 3 times weekly

Acyclovir 400 mg PO BID

Fluconazole 200 mg PO daily

Levofloxacin 500 mg PO daily

Micafungin 50 mg IV q24h

No routine prophylaxis For patients receiving HyperCVAD:

For patients receiving HyperCVAD: Fluconazole 200 mg PO daily Levofloxacin 500 mg PO daily

No routine prophylaxis

No routine prophylaxis

TMP-SMX (Bactrim) DS 3 times weekly (hold through methotrexate admission until level 3,000 I.U./mL for two consecutive readings 7 days apart or or a single level >3,000 I.U./mL with symptoms suggestive of CMV disease or a single level >6,000 I.U./mL, measured at UMHS Labs) Valganciclovir 900 mg PO BID* *Consider ID consult if considering therapy, especially if therapy with valganciclovir felt to be untenable

EBV Surveillance Positive:

Antiviral therapy should NOT be initiated. Contact Hematology/Oncology service for recommendations.

Antimicrobial Subcommittee Approval: 04/2016; 12/2020 P&T Approval: 02/2021

Revision History:

Originated: 04/2016 Last Revised: 02/2021

The recommendations in this guide are meant to serve as treatment guidelines for use at Michigan Medicine facilities. If you are an individual experiencing a medical emergency, call 911 immediately. These guidelines should not replace a provider's professional medical advice based on clinical judgment, or be used in lieu of an Infectious Diseases consultation when necessary. As a result of ongoing research, practice guidelines may from time to time change. The authors of these guidelines have made all attempts to ensure the accuracy based on current information, however, due to ongoing research, users of these guidelines are strongly encouraged to confirm the information contained within them through an independent source.

If obtained from a source other than med.umich.edu/asp, please visit the webpage for the most up-to-date document.

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