Antiinfectious prophylaxis in pediatric oncology

Infections in disease- and/or chemotherapy-related neutropenia are major, o ften emergency-type problems in the treatment of pediatric oncology patient s and explain the ongoing discussion about antiinfectious prophylaxis. The different aspects of prophylaxis and an overview on the literature are presented. Antiinfectious prophylaxis in pediatric oncology includes the following iss ues: 1. General aspects such as information for patients and parents on neu tropenia and risk of infectious diseases and indication and management of r everse isolation and barrier isolation; 2. antibacterial prophylaxis with o ral non-absorbable and oral absorbable antibiotics; 3. Pneumocystis carinii (Pc) prophylaxis; 4, antifungal prophylaxis to prevent disseminated candid iasis and aspergillosis; 5. antiviral prophylaxis, especially varicella-zos ter-virus (VZV) post-exposure prophylaxis and cytomegalovirus (CMV) prophyl axis; 6. immunoglobulins and hematopoietic growth-factors (HGF); 7, active immunization. An evaluation of those measures leads to the following conclusions: A major controversy exists regarding antibacterial and antifungal prophylaxis. Pro bably not effective are the use of reverse isolation and of oral non-absorb able antibiotics. Oral absorbable antibiotics, antifungal prophylaxis using fluconazole and amphotericin B and the use of hematopoietic growth factors are likely to be effective. Clearly effective are strict hand-washing proc edures, Pc and CMV prophylaxis and passive vaccination against VZV in case of VZV exposure of a seronegative patient.