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 ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download