Antimicrobial Prophylaxis in Hematology/Oncology Patients Admitted to ...

Stanford Antimicrobial Safety and Sustainability Program

Antimicrobial Prophylaxis in Hematology/Oncology Patients Admitted to Stanford Health Care

Antibacterial

General

Considerations

?

?

Utility

Reduce risk of bacteremia and fever

Potential mortality benefit

Levofloxacin

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)

ANC 7 days

Weigh risks of prolonged

antimicrobial exposure (e.g.

MDRO colonization, C. difficile

infection, etc.)

If intolerance, contraindication, or

allergy to fluoroquinolone:

cefpodoxime

Consider during neutropenia

No routine prophylaxis

Consider during neutropenia

No routine prophylaxis

No routine prophylaxis

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 during neutropenia

Consider fluconazole during

neutropenia

No routine prophylaxis

No routine prophylaxis

No routine prophylaxis

No routine prophylaxis

Consider during neutropenia

Consider fluconazole during

neutropenia

Antiviral

PJP

? HSV or VZV seropositive

? Prior HSV or VZV

episode

? T-cell suppression

? Prolonged neutropenia

? Mucositis

Reduce risk of viral

reactivation

Acyclovir

? >3.5% risk of developing PJP

? T-cell suppression (especially

CD4 ................
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