Key points
- Fluoroquinolone prophylaxis only for expected deep and prolonged neutropenia (ANC below 100 for more than 7 days) [1].
- A mould-active antifungal in AML/MDS induction and in GVHD [1].
- Co-trimoxazole for pneumocystis with high-risk treatments [1, 2].
- Inactivated vaccines preferably two weeks before chemotherapy; live vaccines are contraindicated during treatment [3].
Antimicrobial prophylaxis
| Infection | High-risk group | Drug |
|---|---|---|
| Bacteria | Deep neutropenia for more than 7 days (acute leukaemia induction, transplant) | Levofloxacin or ciprofloxacin |
| Fungi (moulds) | AML or MDS induction, GVHD under treatment | Posaconazole (or another mould-active antifungal) |
| Pneumocystis | The equivalent of 20 mg prednisone or more for 4 weeks or longer, ALL, purine analogues (fludarabine), alemtuzumab, temozolomide with radiotherapy, allogeneic transplant | Co-trimoxazole (three times a week or daily) |
| Herpes and shingles | Bortezomib, purine analogues, leukaemia induction, transplant, daratumumab | Aciclovir or valaciclovir |
| Hepatitis B | HBsAg or anti-HBc positive with anti-CD20 or high-risk chemotherapy | Entecavir or tenofovir [4] |
Vaccination
- Influenza: inactivated vaccine every year for the patient and household contacts [3].
- Pneumococcus: a conjugate vaccine (for example PCV20, or PCV15 followed by PPSV23) [3].
- Shingles: the recombinant (non-live) vaccine in immunocompromised adults; the live shingles vaccine is contraindicated [3].
- COVID-19 and hepatitis B according to the guideline [3].
- Timing: preferably at least 2 weeks before chemotherapy; after anti-CD20 treatment the vaccine response is weak for about 6 months [3].
- Live vaccines: MMR, varicella and yellow fever are contraindicated during chemotherapy and for at least 3 months afterwards; after transplant, revaccination starts 3 to 6 months later [3].
References
4 referencesShow all references, 2 with a study cardClose the reference list
Numbers in the text, such as [1], refer to these sources. Sources with a “Study card” button are summarised in the site’s evidence library.
- 1
- 2
- 3
- 4Hepatitis B Virus Screening and Management for Patients With Cancer Prior to Therapy: ASCO Provisional Clinical Opinion Update
This page is based on reputable scientific sources and was last updated on 28 October 2026. The content of this website is for educational and informational purposes only and does not replace consultation, diagnosis or treatment by a specialist physician. Consult your treating physician about any treatment decision.
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