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Antimicrobial Prophylaxis

  • Yanina PasikhovaEmail author
Chapter

Abstract

During the period of neutropenia (ANC < 500 cells/mm3) following cytotoxic chemotherapy and hematopoietic stem cell transplantation (HSCT) oncology patients are at a significant risk for infections (Freifeld et al., Clin Infect Dis 52(4):e56–e93, 2011). Patients with profound neutropenia, defined as ANC < 100 cells/mm3 are at greatest risk with bacteremia rates reported as high as 20%, often with septic shock and multi-system organ failure (Freifeld et al., Clin Infect Dis 52(4):e56–e93, 2011; Horton et al., Curr Hematol Malig Rep13:59, 2018).

A number of modalities have been evaluated to mitigate the risk of infections in vulnerable oncology patients with neutropenia. Among the most widely utilized has been the use of antimicrobial prophylaxis during the time of afebrile neutropenia. Recommendations for prophylaxis vary based on overall risk of infections as determined by disease state and treatment received. Low risk patients are typically those with solid tumors receiving standard chemotherapy with anticipated neutropenia less than 7 days (Freifeld et al., Clin Infect Dis 52(4):e56–e93, 2011; National Comprehensive Cancer Network. Prevention and treatment of cancer-related infections (Version 1.2018). https://www.nccn.org/professionals/physician_gls/pdf/infections.pdf . Accessed 11 Apr 2018). Such patients do not routinely require bacterial, fungal or viral prophylaxis (Freifeld et al., Clin Infect Dis 52(4):e56–e93, 2011; National Comprehensive Cancer Network. Prevention and treatment of cancer-related infections (Version 1.2018). https://www.nccn.org/professionals/physician_gls/pdf/infections.pdf . Accessed 11 Apr 2018). On the other hand patients undergoing HSCT or those receiving treatment for acute leukemia are considered high risk for infections and thus typically received bacterial, fungal and viral prophylaxis (Freifeld et al., Clin Infect Dis 52(4):e56–e93, 2011; National Comprehensive Cancer Network. Prevention and treatment of cancer-related infections (Version 1.2018). https://www.nccn.org/professionals/physician_gls/pdf/infections.pdf . Accessed 11 Apr 2018).

Keywords

Antibacterial prophylaxis Antifungal Prophylaxis Antiviral prophylaxis Prophylactic antibiotics Neutropenia Allogeneic HSCT Autologous HSCT Induction chemotherapy Gastrointestinal mucositis 

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of PharmacyMofitt Cancer CenterTampaUSA

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