Haematology & Oncology

Indication

Prophylaxis against muco-cutaneous candida infection (not recommended if anticipated duration of neutropenia <7 days)

First Line Antimicrobials

Nystatin 4mL QDS - Patient needs to be able to swish suspension in mouth and then swallow

OR

Fluconazole ^# 50mg OD PO

^# Consider potential for interactions with other drugs including those that may prolong the QT interval and drugs metabolised by CYP3A or P-gp. Please check SmPC or with pharmacy

Indication

Primary prophylaxis against aspergillus or mould infection, indicated for

• Patients with acute myeloid leukaemia on induction chemotherapy or azacitidine/venetoclax
• Patients on acute myeloid leukaemia on azacitidine
• Patients with anticipated duration of neutropenia >10 days
• Allogeneic HSCT

For patients with prior history of invasive fungal infection (with aspergillus or other mould), always discuss antifungal prophylaxis choice with clinical microbiologist

First Line Antimicrobials

Posaconazole TABS ^#

300mg BD on day 1

300mg OD day 2 onwards

#Consider potential for interactions with other drugs including those that may prolong the QT interval and drugs metabolised by CYP3A or P-gp. Please check SmPC or with pharmacy

NB. POSACONAZOLE TABLET & LIQUID FORMS ARE NOT INTERCHANGEABLE – DOSES ARE DIFFERENT

If posaconazole contra-indicated, discuss alternative agent with clinical microbiology team

Indication

Prophylaxis against reactivation of HSV, indicated for

• Acute Myeloid Leukaemia
• Myelodysplastic Syndromes on azacitidine
• Aplastic Anaemia
• Lymphoma on SACT or anti-CD20 maintenance
• CLL on BTK inhibitor or BCL2 inhibitor
• Myeloma on SACT
• MPN on JAK inhibitor

First Line Antimicrobials

Valaciclovir 500mg OD PO

Indication

Prophylaxis against Pneumocystis jirovecii pneumonia (PJP), indicated for

• Treatment regimens with high dose steroids OR prolonged steroid use including neutropenic and non-neutropenic patients (e.g., CNS lymphoma or brain metastases)
• Purine analogue (e.g., fludarabine)
• Aplastic anaemia prescribed anti-thymocyte globulin (ATG)
• Alemtuzumab (Campath)
• If recommended in specific chemotherapy protocol

First Line Antimicrobials

Co-trimoxazole 480mg OD PO

If creatinine >250: Co-trimoxazole 480mg ALTERNATE DAYS PO

If intolerant of or allergic to co-trimoxazole:

Atovaquone  1500mg OD PO (take with food)

Comments

Co-trimoxazole (TMP-SMX) also provides prophylaxis against toxoplasmosis, nocardioisis, listeriosis, actinomycosis and infection with susceptible Enterobacterales

Indication

Sickle Cell Disease Crisis with Evidence of Infection

First Line Antimicrobials

Cef-TRI-axone 2g OD IV

ADD Clarithromycin 500mg BD PO ( or Clarithromycin 500mg BD IV only where oral route is not feasible - excellent oral bioavailability) if evidence of community-acquired pneumonia.

Comments

N.B. Send blood cultures, MSU, stool (if diarrhoea), sputum/ respiratory viral swab/ pneumocococcal and legionella urinary antigens (if respiratory infection).

Consider malaria and refer to Malaria treatment guideline if relevant travel history.

People with sickle cell disease (SCD) have an increased risk of severe bacterial infection, resulting primarily from asplenia or hyposplenia. On recovery from acute infection, they should start (or restart) antibiotic prophylaxis (usually penicillin) and receive relevant vaccinations. Please refer to splenic dysfunction prophylaxis guideline for detailed guidance on prevention of infection in this patient population.

Duration of treatment

Review at 48 hours with culture results.