Antimicrobial Prophylaxis
Table 2. Summary of Recommendations for Antimicrobial
Prophylaxis
Type of
prophylaxis Population Recommendations Timing of prophylaxis
Antibacterial Patients at high
risk of febrile
neutropenia
(Table 1) or
profound,
protracted
neutropenia
Fluoroquinolone
prophylaxis is
recommended.
During period of expected
neutropenia.
Antifungal Patients at high
risk of febrile
neutropenia
(Table 1) or
profound,
protracted
neutropenia
Patients with gra
versus host disease
(GVHD)
Oral triazole
or parenteral
echinocandin
prophylaxis is
recommended; a
mold-active triazole is
recommended where
the risk of invasive
aspergillosis is >6%,
such as in patients
with AML/MDS, or
during treatment of
GVHD.
During period of expected
neutropenia.
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)
Prophylaxis is
recommended.
Post-myeloid
reconstitution or
engrament aer
SCT, particularly in
the setting of post-
engrament augmented
immunosuppression (for
the treatment of GVHD).
Antiviral HSV-seropositive
patients undergoing
HSCT or leukemia
induction therapy
Antiviral
prophylaxis with a
nucleoside analog is
recommended (e.g.
acyclovir).
Until recovery of the
white blood cell count or
resolution of mucositis,
whichever occurs later.
Duration can be extended
for persons with frequent
recurrent HSV infections
or those with GVHD or
can be continued as VZV
prophylaxis for up to one
year.
