Viruses
Î Lamivudine is recommended for prophylaxis in patients at substantial risk
for reactivation of hepatitis B infection.
Î Use a nucleoside analog as prophylaxis to prevent reactivation of infection
due to Herpesviruses (Herpes simplex virus or Herpes zoster virus) in
seropositive patients being treated for certain hematologic malignancies
(see details in the full guideline).
Î Seasonal influenza immunization is recommended for all patients
receiving chemotherapy for malignancy, and for all family and household
contacts.
• Utilize trivalent inactivated vaccine for influenza immunization.
• In select circumstances following proven exposure of a susceptible cancer patient,
a neuraminidase inhibitor (eg, oseltamivir, zanamivir) may be offered.
Additional Precautions
Î All healthcare workers should follow hand hygiene guidelines including:
• Handwashing practices to reduce exposure through contact transmission and
• Respiratory hygiene/cough etiquette guidelines to reduce exposure through droplet
transmission.
Î Outpatients with neutropenia due to cancer therapy should avoid
prolonged contact with environments that have high concentrations of
airborne fungal spores (eg, construction and demolition sites).
Î None of the following measures is routinely necessary to prevent infection
of afebrile outpatients with a malignancy and neutropenia:
• Protected environments (High-Efficiency Particulate Air [HEPA] filters with or
without laminar air flow)
• Respiratory or surgical masks (to prevent invasive aspergillosis)
• Footwear exchange at entry and exit
• A "neutropenic diet" or similar nutritional interventions.
Note: Gowning and gloving should be considered only in accordance with local Infection
Prevention and Control practices for antibiotic-resistant organisms –
eg, methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, or
extended-spectrum ß-lactamase-producing and carbapenemase-producing Gram-negative
bacilli.
Selecting for Outpatient Therapy
Î Medical complications of FN occur in as many as 11% of patients
identified as low risk for medical complications in studies validating risk
indices or scoring systems. Therefore inpatient treatment is the standard
approach for managing an FNE. However, outpatient management may be
acceptable for carefully selected patients.
