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Guidelines
Antimicrobial Prophylaxis for Myelosuppressive Chemotherapy

Antimicrobial Prophylaxis for Myelosuppressive Chemotherapy

Guideline Use

The recommendations in this guideline apply to adult inpatients receiving myelosuppressive chemotherapy at Northern Light Eastern Maine Medical Center

Deviations from the following recommendations may occur based on patient-specific risk-benefit considerations, and adequate documentation of such

Indications for Prophylaxis

  • AML – Induction Therapy
  • HSCT – Myeloablative conditioning
  • Myelodysplastic syndrome
  • Other scenarios with high-risk of prolonged (≥ 7 days ) severe (< 100 cells/mcl) neutropenia
  • AML – Induction Therapy
  • HSCT – Myeloablative conditioning
  • Myelodysplastic syndrome
  • Other scenarios with high-risk of prolonged (≥ 7 days ) severe (< 100 cells/mcl) neutropenia
  • AML - Induction Therapy; AND HSV (+)
  • HSCT – Dependent on donor status

> 3.5% risk of developing PCP

  • Common indications*:
    • ≥ 20 mg prednisone equivalent daily for ≥ 1 month
    • ALL
    • Purine-analogue containing therapy
    • PI3K Inhibitors

*Not an exhaustive list and risk should be determined for each regimen

Management Considerations

  • On the day of admission for chemotherapy, the Grant 6 pharmacist will review the plan for prophylaxis as documented by the admitting oncologist
  • The pharmacist will contact the in-house oncologist to discuss adjustments based on indication, renal function, drug-drug interactions, patient allergies, and other patient-specific factors
  • If admission occurs on a weekend, the grant 6 pharmacist will review on the following Monday

Additional Information

Taplitz, et al. Antimicrobial prophylaxis for adult patients with cancer-related immunosuppression: ASCO and IDSA clinical practice guideline update. 2018;36(30): 3034-3054.