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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