What are the current guidelines for prophylaxis against fungal infections in high-risk populations, such as those undergoing chemotherapy?

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 ¹.

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., 2011; Mellinghoff 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 ¹.

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., 2011; Rabagliati and Santolaya, 2012; Mellinghoff et al., 2018) ¹.