Science, M., Robinson, P.D., MacDonald, T., Rassekh, S.R., Dupuis, L.L., & Sung, L. (2014). Guideline for primary antifungal prophylaxis for pediatric patients with cancer or hematopoietic stem cell transplant recipients. Pediatric Blood and Cancer, 61, 393–400.

PURPOSE: To provide healthcare providers with evidence-based recommendations on the use of primary antifungal prophylaxis in children with cancer and undergoing hematopoietic stem cell transplantation (HSCT)

TYPES OF PATIENTS ADDRESSED: Allogeneic and autologous HSCT recipients, children with acute myelogenous leukemia (AML) or myelodysplastic syndrome (MDS), and pediatric patients with anticipated neutropenia for longer than seven days

RESOURCE TYPE: Evidence-based guideline 

PROCESS OF DEVELOPMENT: Literature search was done, and included studies were evaluated using the Grades of Recommendation, Assessment, Development, and Evaluation system. Recommendations were established by a panel discussion. Guidelines then were externally reviewed by another interprofessional expert panel and provided to Canadian pediatric tertiary hospitals for stakeholder review.

DATABASES USED: MEDLINE, EMBASE, Cochrane Collaboration, proceedings of the American Society of Clinical Oncology and American Society of Hematology    

KEYWORDS: Not stated

INCLUSION CRITERIA: RCTs involving patients of any age with cancer or undergoing HSCT that compared antifungal agents with another antifungal agent, placebo, or no prophylaxis; no language exclusions

EXCLUSION CRITERIA: Trials involving nonsystemic antifungal treatment

• PHASE OF CARE: Multiple phases of care            
• APPLICATIONS: Pediatrics

Initially, 7,869 references were retrieved and screened. A final set of 47 studies were included.

The following are strong recommendations.

• Children one month to 19 years undergoing allogeneic HSCT should have fluconazole daily from the start of conditioning until engraftment (high-quality evidence).
• When fluconazole is contraindicated, echinocandin should be used as an alternative (moderate-quality evidence).
• Children undergoing autologous HSCT with anticipated neutropenia for longer than seven days should receive fluconazole daily from the start of conditioning until engraftment (moderate-quality evidence).
• Children with AML or MDS should receive fluconazole daily during chemotherapy-associated neutropenia (moderate-quality evidence).

Additional weak recommendations also are outlined in the guidelines.

Although these guidelines are aimed at pediatric patients, 17 studies included did not include children in the sample.

These evidence-based guidelines clearly recommend primary antifungal prophylaxis in at-risk children. Specific dosages recommended are identified in this reference.