The purpose of this document is to provide guidance regarding antifungal prophylaxis in patients with haematological malignancy or profound neutropenia > 10 days, and is intended to be used as a guide only. Antifungal prophylaxis should not be used routinely in all patients with neutropenia. The rationale for antifungal prophylaxis is to prevent fungal infections in a targeted group of high risk patients, especially those with longer durations of neutropenia or with graft versus host disease (GvHD) post allogeneic blood and marrow transplant (BMT).
Whether to use antifungal prophylaxis should be informed, where possible, by local rates of invasive fungal infection (IFI) in different patient populations. If prophylaxis is to be used, the choice of antifungal agent should be guided by institutional types of invasive fungal infection in specific groups, in particular whether candida or moulds are the main pathogens observed. Other factors that affect drug selection include host risk-stratification, and the effectiveness, toxicity, drug-drug interactions and accessibility of therapeutic drug monitoring for the antifungal agents being considered. Advice from local infectious diseases, microbiology or infection control experts should be sought regarding these issues. As a result of these and other issues, practices regarding antifungal prophylaxis differ widely at various institutions, and this document may be different from the approach recommended at a specific institution.