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 or marrow transplant (BMT).
Consideration for antifungal prophylaxis should be determined, where possible, by local rates of invasive fungal infection (IFI) in specific 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 causative pathogens. Other factors that affect drug selection include: host risk-stratification; and the effectiveness, toxicity, drug-drug interactions and therapeutic drug monitoring capacity of 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 such issues, there may be wide variations in institutional practice regarding antifungal prophylaxis, and thus recommendations in this document may differ from those of specific institutions.