Antimicrobial prophylaxis of bacterial infections in pediatric oncology patients.

Bacterial infections are still a major challenge in the treatment of pediat ric cancer patients. Considering the evidence in the literature and publish ed consensus opinions of experts the following strategies of antibacterial chemoprophylaxis (ABCP) in pediatric cancer patients can be recommended (or not recommended): Accompanying the implantation of a ventriculoperitoneal shunt (or a Rickham-reservoir) ABCP is recommended, until prospective contr olled studies including pediatric cancer patients have investigated this is sue. In bone marrow or stem cell transplant recipients, the prophylactic ad ministration of penicillin should be considered, if severe oral mucositis i s a common adverse event in cancer departments with high rates of penicilli n-susceptible strains of Streptococcus viridans. Prospective surveillance o f resistant bacterial pathogens should be an indispensable tool of quality control in pediatric oncology departments. The risk of infection with antim icrobial-resistant isolates should be balanced against the real benefit of antimicrobial prophylaxis in every instance. ABCP should neither be given d uring implantation nor during prolonged usage to prevent bacterial infectio n of a central venous access device (unproven efficacy and potential hazard s of Vancomycin-resistant gram-positive infections). The oral administratio n of non-absorbable ABCP or Trimetoprim-Sufomethoxazole is not recommended for the prevention of bacterial infections (unproven efficacy) and no recom mendation can be given for the oral ABCP with chinolones (lacking data, ris k of antimicrobial resistance).