Antimicrobial Prophylaxis for Cancer Patients Clinical Practice Guidelines (2018)

American Society of Clinical Oncology and Infectious Diseases Society of America

Reviewed and summarized by Medscape editors

September 27, 2018

The joint guidelines on antimicrobial prophylaxis in cancer patients were released on September 4, 2018, by ASCO and IDSA.[1,2]

Risk for febrile neutropenia should be systematically assessed, in consultation with infectious disease specialists as needed. Patients at risk include those who are expected to have profound, protracted neutropenia, which is defined as <100 neutrophils/µL for >7 days or other risk factors.

Prophylaxis with a fluoroquinolone is recommended for those at high risk for febrile neutropenia or profound, protracted neutropenia. This would include patients with acute myeloid leukemia/myelodysplastic syndromes (AML/MDS) or patients who have undergone hematopoietic stem cell transplantation (HSCT) treated with myeloablative conditioning regimens. Antibiotic prophylaxis is not routinely recommended for cancer patients with solid tumors.

Antifungal prophylaxis with an oral triazole or parenteral echinocandin is recommended for patients who are at risk for profound, protracted neutropenia. This would include most patients with AML/MDS or HSCT. It is not routinely recommended for patients with solid tumors.

Prophylaxis (eg, with trimethoprim-sulfamethoxazole) is recommended for patients receiving chemotherapy regimens associated with >3.5% risk for pneumonia from Pneumocystis jirovecii.

Patients who are seropositive for herpes simplex virus and who undergo allogeneic HSCT or leukemia induction therapy should receive prophylaxis with a nucleoside analogue.

Treatment with a nucleoside reverse transcriptase is recommended for patients who are at high risk for hepatitis B virus reactivation.

Annual influenza vaccination with inactivated vaccine is recommended for all chemotherapy patients and all family and household contacts and healthcare providers.

The expert panel also supports the vaccination recommendations for immunosuppressed adult oncology patients that are contained in the IDSA guideline for vaccination of the immunosuppressed host.


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