Guideline for Antibacterial Prophylaxis Administration in Pediatric Cancer and Hematopoietic Stem Cell Transplantation

Thomas Lehrnbecher, Brian T Fisher, Bob Phillips, Sarah Alexander, Roland A Ammann, Melissa Beauchemin, Fabianne Carlesse, Elio Castagnola, Bonnie L Davis, L Lee Dupuis, Grace Egan, Andreas H Groll, Gabrielle M Haeusler, Maria Santolaya, William J Steinbach, Marianne van de Wetering, Joshua Wolf, Sandra Cabral, Paula D Robinson, Lillian Sung

Research output: Contribution to journalArticlepeer-review


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.

Original languageEnglish
Pages (from-to)226-236
Number of pages11
JournalClin. Infect. Dis.
Issue number1
Publication statusPublished - Jun 24 2020


  • Anti-Bacterial Agents/therapeutic use
  • Antibiotic Prophylaxis
  • Bacteremia/drug therapy
  • Child
  • Hematopoietic Stem Cell Transplantation
  • Humans
  • Levofloxacin
  • Neoplasms/drug therapy


Dive into the research topics of 'Guideline for Antibacterial Prophylaxis Administration in Pediatric Cancer and Hematopoietic Stem Cell Transplantation'. Together they form a unique fingerprint.

Cite this