Guideline for Antibacterial Prophylaxis Administration in Pediatric Cancer and Hematopoietic Stem Cell
Thomas Lehrnbecher1, Brian T Fisher2, Bob Phillips3,4
1Pediatric Hematology and Oncology, Hospital for Children and Adolescents, Johann Wolfgang Goethe University, Frankfurt am Main, Germany.
Insights
This clinical practice guideline advises on antibacterial prophylaxis for children with cancer and those undergoing stem cell transplants. Prophylaxis is recommended for specific high-risk leukemia and transplant cases, with levofloxacin suggested during neutropenia.
Area of Science:
- Pediatric Oncology
- Hematopoietic Stem Cell Transplantation (HSCT)
- Infectious Diseases
Background:
- Bacteremia and invasive bacterial infections are significant risks for pediatric cancer patients on chemotherapy and HSCT recipients.
- Systemic antibacterial prophylaxis is a strategy to mitigate these infection risks.
- A clinical practice guideline (CPG) was needed to standardize prophylaxis in these vulnerable pediatric populations.
Purpose of the Study:
- To develop a clinical practice guideline (CPG) for administering systemic antibacterial prophylaxis.
- To provide evidence-based recommendations for pediatric cancer patients and HSCT recipients.
Main Methods:
- An international, multidisciplinary panel convened, including experts in pediatric hematology/oncology, HSCT, infectious diseases, nursing, pharmacy, and patient advocacy.
- The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was utilized.
- Recommendations were based on a systematic review of 114 eligible randomized trials of antibiotic prophylaxis.
Main Results:
- A weak recommendation supports antibacterial prophylaxis for children with acute myeloid leukemia and relapsed acute lymphoblastic leukemia (ALL) undergoing intensive chemotherapy.
- Weak recommendations advise against routine prophylaxis for children undergoing induction chemotherapy for ALL, and for autologous or allogeneic HSCT.
- A strong recommendation discourages routine prophylaxis for patients not expected to have prolonged severe neutropenia; levofloxacin is recommended if prophylaxis is used during severe neutropenia.
Conclusions:
- A clinical practice guideline for systemic antibacterial prophylaxis in pediatric cancer and HSCT patients is presented.
- Further research is recommended to assess the long-term efficacy and adverse effects of prophylaxis.
Background:
Bacteremia and other invasive bacterial infections are common among children with cancer receiving intensive chemotherapy and in pediatric recipients of hematopoietic stem cell transplantation (HSCT). Systemic antibacterial prophylaxis is one approach that can be used to reduce the risk of these infections. Our purpose was to develop a clinical practice guideline (CPG) for systemic antibacterial prophylaxis administration in pediatric patients with cancer and those undergoing HSCT.
Methods:
An international and multidisciplinary panel was convened with representation from pediatric hematology/oncology and HSCT, pediatric infectious diseases (including antibiotic stewardship), nursing, pharmacy, a patient advocate, and a CPG methodologist. The panel used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach to generate recommendations based on the results of a systematic review of the literature.
Results:
The systematic review identified 114 eligible randomized trials of antibiotic prophylaxis. The panel made a weak recommendation for systemic antibacterial prophylaxis for children receiving intensive chemotherapy for acute myeloid leukemia and relapsed acute lymphoblastic leukemia (ALL). Weak recommendations against the routine use of systemic antibacterial prophylaxis were made for children undergoing induction chemotherapy for ALL, autologous HSCT and allogeneic HSCT. A strong recommendation against its routine use was made for children whose therapy is not expected to result in prolonged severe neutropenia. If used, prophylaxis with levofloxacin was recommended during severe neutropenia.
Conclusions:
We present a CPG for systemic antibacterial prophylaxis administration in pediatric cancer and HSCT patients. Future research should evaluate the long-term effectiveness and adverse effects of prophylaxis.
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