Antimicrobial Prophylaxis in Hematology/Oncology …
Stanford Antimicrobial Safety and Sustainability Program
Antimicrobial Prophylaxis in Hematology/Oncology Patients Admitted to Stanford Health Care
General Considerations
Utility Agents
Preferred Alternative
AML Induction
Consolidation or lowintensity treatment
ALL Induction
through maintenance Blinatumomab (for
relapsed/refractory ALL) Lymphoma
Most regimens Intensive chemotherapy
(e.g. R-CODOX-M/RIVAC, HyperCVAD) MT-R for PCNSL
Multiple Myeloma Proteasome inhibitors Daratumumab
Intensive chemotherapy (e.g. VTE-PACE)
Antibacterial ? ANC 7 days ? Weigh risks of prolonged
antimicrobial exposure (e.g. MDRO colonization, C. difficile infection, etc.)
Reduce risk of bacteremia and fever Potential mortality benefit Levofloxacin
If intolerance, contraindication, or allergy to fluoroquinolone: cefpodoxime
Consider during neutropenia
No routine prophylaxis
Consider during neutropenia
No routine prophylaxis
No routine prophylaxis
Consider during neutropenia
No routine prophylaxis
No routine prophylaxis
Consider during neutropenia
Antifungal ? ANC 7 days ? Mucositis (increased candidiasis risk) ? >10% risk of candidiasis ? Consider mold-active prophylaxis
when >6-8% risk of aspergillosis
Reduce risk of fungal infection and related mortality Fluconazole (candida prophylaxis only) Posaconazole (mold-active prophylaxis) If drug interaction, intolerance, or contraindication (consider spectrum indicated): caspofungin, isavuconazole, liposomal amphotericin B, voriconazole Posaconazole during neutropenia
Consider posaconazole if ANC 7 days Fluconazole or caspofungin during neutropenia (see appendix for spectrum) Consider mold-active prophylaxis based on duration and depth of neutropenia No routine prophylaxis
Consider fluconazole during neutropenia
No routine prophylaxis
No routine prophylaxis
Consider fluconazole during neutropenia
Antiviral ? HSV or VZV seropositive ? Prior HSV or VZV
episode ? T-cell suppression ? Prolonged neutropenia ? Mucositis Reduce risk of viral reactivation Acyclovir
If patient preference: famciclovir, valacyclovir
During treatment course
During treatment course
Consider during treatment course Consider during treatment course
During treatment course During treatment course and 3 months after Consider during treatment course
PJP ? >3.5% risk of developing PJP ? T-cell suppression (especially
CD4 ................
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