Current guidelines for prophylaxis against fungal infections in high-risk populations, such as patients undergoing chemotherapy, emphasize targeted antifungal prophylaxis primarily in patients with anticipated prolonged and profound neutropenia, particularly those with hematological malignancies or undergoing stem cell transplantation. UK guidance on neutropenic sepsis prevention recommends antibacterial prophylaxis with fluoroquinolones during expected neutropenia but does not explicitly mandate routine antifungal prophylaxis for all chemotherapy patients; instead, antifungal prophylaxis is considered based on individual risk factors and clinical context NICE CG151.
International and specialist infectious diseases literature, including the Infectious Diseases Society of America (IDSA) and German Society for Haematology and Medical Oncology (DGHO) recommendations, support primary antifungal prophylaxis in patients with hematological malignancies who are at high risk for invasive fungal infections (IFIs), such as those with acute leukemia or undergoing allogeneic stem cell transplantation. Commonly recommended agents include triazole antifungals like posaconazole or voriconazole, which have demonstrated efficacy in reducing IFI incidence in these populations Freifeld et al. 2011Mellinghoff et al. 2018.
Prophylaxis decisions should consider the patient’s degree and duration of neutropenia, underlying disease, and local epidemiology of fungal pathogens. Monitoring for antifungal resistance and adverse effects is essential. The UK guidelines highlight the importance of individualized risk assessment and do not recommend routine granulocyte-colony stimulating factor (G-CSF) solely for infection prophylaxis unless part of chemotherapy regimen NICE CG151.
In summary, UK practice integrates antibacterial prophylaxis during neutropenia with a tailored approach to antifungal prophylaxis guided by specialist recommendations and patient risk profiles, aligning with international expert consensus advocating antifungal prophylaxis in high-risk hematology patients to prevent invasive fungal infections Freifeld et al. 2011Rabagliati 2012Mellinghoff et al. 2018 NICE CG151.
Key References
- CG151 - Neutropenic sepsis: prevention and management in people with cancer
- NG51 - Suspected sepsis: recognition, diagnosis and early management
- (Freifeld et al., 2011): Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the infectious diseases society of america.
- (Rabagliati and Santolaya, 2012): [Prophylaxis against fungal infections in solid organ and hematopoietic stem cells transplantation].
- (Mellinghoff et al., 2018): Primary prophylaxis of invasive fungal infections in patients with haematological malignancies: 2017 update of the recommendations of the Infectious Diseases Working Party (AGIHO) of the German Society for Haematology and Medical Oncology (DGHO).