Assessment
Prophylaxis
Î Use G-CSF prophylaxis before neutropenia develops in patients who meet
criteria specified in ASCO's WBC growth factors guideline. (http://www.
jco.org/cgi/reprint/JCO.2006.06.4451v2.pdf)
Bacteria
Î Consider antibacterial prophylaxis only for patients expected to experience
profound neutropenia (ANC <100/µL) likely to last for ≥7 days.
Note: Routine antibacterial prophylaxis is NOT recommended if neutropenia is less severe
or of shorter duration, which is the usual result from current chemotherapy regimens for
solid tumors – ie, for patients with solid tumors undergoing conventional chemotherapy
with or without biologics (eg, trastuzumab, bevacizumab, or cetuximab).
Î Use an orally administered, systemically absorbed fluoroquinolone to
prevent invasive infection by Gram-negative bacilli in outpatients with
profound neutropenia expected for ≥7 days that is associated with severe
mucositis (eg, from primary or salvage remission-induction therapy for
acute leukemia, dose-intensive post-remission consolidation for acute
leukemia, or hematopoietic stem cell transplantation).
Note: Prophylaxis may be less effective in environments where >20% of Gram-negative
bacilli are resistant to fluoroquinolones.
Fungi
Î Limit antifungal prophylaxis (for decreasing invasive fungal infections
(IFI) due to opportunistic yeast or mold species) to patients receiving
chemotherapy that is expected to cause profound neutropenia (ANC
<100/µL) for ≥7 days, since this confers substantial risk (>6%-10%) for IFI.
Note: Antifungal prophylaxis is NOT recommended for patients with solid tumors
receiving conventional-dose chemotherapy with or without biologics (eg, trastuzumab,
bevacizumab, cetuximab).
• Use an orally administered triazole antifungal or a parenterally administered
echinocandin in the outpatient setting as prophylaxis against opportunistic yeast
infection in those with profound neutropenia and mucositis expected to last for
≥7 days in environments with >10% risk of invasive Candida infection.
Note: A mold-active triazole is recommended in environments with a substantial risk
(>6%) for invasive aspergillosis.
Pneumocystis
Î Patients receiving chemotherapy regimens associated with >3.5% risk
for pneumonia due to Pneumocystis jirovecii (eg, those with ≥20 mg
of prednisone equivalents daily for ≥1 month, or those based on purine
analogs) are eligible for prophylaxis.
Î Use prophylaxis with trimethoprim-sulfamethoxazole only if risk for
pneumonia due to Pneumocystis jirovecii is >3.5% (eg, patients given
regimens with ≥20 mg of prednisone equivalents daily for ≥1 month, or
those based on purine analogs).
Note: Additional details and alternatives for patients with sulfa-based hypersensitivities
are provided in the full guideline.
