Antimicrobial Prophylaxis
➤ Prophylaxis is recommended, e.g. trimethoprim-sulfamethoxazole (TMP-SMX),
for patients receiving chemotherapy regimens associated with >3.5% risk for
pneumonia from Pneumocystis jirovecii (e.g. those with ≥20 mg prednisone
equivalents daily for ≥1 month or those based on purine analogs). (Strong
Recommendation; EB-B-H)
➤ Herpes simplex virus (HSV)-seropositive patients undergoing allogeneic HSCT or
leukemia induction therapy should receive prophylaxis with a nucleoside analog
(e.g. acyclovir). (Strong Recommendation; EB-B-H)
➤ Treatment with a nucleoside reverse transcriptase inhibitor (e.g. entecavir,
tenofovir) is recommended for patients at high risk of Hepatitis B reactivation.
(Moderate Recommendation; CB-B-I)
➤ Yearly influenza vaccination with inactivated vaccine is recommended for all
patients receiving chemotherapy for malignancy and for all family and household
contacts, and health care providers. (Moderate Recommendation; CB-B-I)
➤ The Expert Panel also supports other vaccination recommendations for
immunosuppressed adult oncology patients that are contained within the
IDSA guideline for vaccination of the immunosuppressed host. (Moderate
Recommendation; CB-B-I)
Rubin LG, Levin MJ, Ljungman P, et al: 2013 IDSA clinical practice guideline for vaccination of the
immunocompromised host. Clin Infect Dis 58:e44-100, 2014.
Additional recommended precautions:
➤ All health care workers should comply with hand hygiene and respiratory
hygiene/cough etiquette guidelines to reduce the risk for aerosol- and direct
or indirect contact-based transmission of pathogenic microorganisms in the
healthcare setting. (Strong Recommendation; CB-B-I).
➤ Outpatients with neutropenia from cancer therapy should avoid prolonged
contact with environments that have high concentrations of airborne fungal
spores (e.g. construction and demolition sites, intensive exposure to soil through
gardening or digging, household renovation). (Strong Recommendation; CB-B-I)
