Updated Pediatric Cancer Guidelines Address Antibacterial and Antifungal Prophylaxis

The Pediatric Oncology Group of Ontario has updated and harmonized its guidelines for systemic antibacterial and antifungal prophylaxis in pediatric patients with cancer and hematopoietic cell transplantation (HCT) recipients. An international multidisciplinary panel used the GRADE approach to assess evidence and formulate recommendations. Updated systematic reviews identified 13 randomized trials published since 2019—eight antibacterial and five antifungal—bringing the evidence base to 195 trials involving pediatric and adult populations.

The panel retained a conditional recommendation to consider antibacterial prophylaxis for pediatric patients with acute myeloid leukemia (AML) or relapsed acute lymphoblastic leukemia. It also retained a strong recommendation to use levofloxacin when antibacterial prophylaxis is planned. A new conditional recommendation advises considering no antibacterial prophylaxis for patients unable to receive levofloxacin.

Strong recommendations for antifungal prophylaxis in pediatric patients with AML and allogeneic HCT recipients remain unchanged. When antifungal prophylaxis is planned, the panel continues to strongly recommend an echinocandin or mold-active azole. Three new good practice statements address drug interactions, infection prevention practices, and monitoring infection epidemiology.

The update supports risk-specific prophylaxis decisions rather than uniform antibacterial use. The supplied abstract does not report effect estimates or detailed evidence-quality ratings, and the evidence base includes adult trials. The authors identify refinement of prophylaxis indications for specific patient subgroups as a research priority.