From the Guidelines
Pediatric oncology patients are at high risk for infectious complications due to chemotherapy-induced immune suppression and require comprehensive infection prevention strategies. These patients are vulnerable to various infections, including bacterial, fungal, and viral infections, due to their compromised immune system. The risk of infection is further increased by the use of intensive chemotherapy regimens, which can cause prolonged neutropenia and compromise mucosal barriers. According to the clinical practice guideline for systemic antifungal prophylaxis in pediatric patients with cancer and hematopoietic stem-cell transplantation recipients 1, antifungal prophylaxis with fluconazole (6-12mg/kg/day) is recommended for patients with prolonged neutropenia or receiving intensive regimens. Additionally, the guideline for antibacterial prophylaxis administration in pediatric cancer and hematopoietic stem cell transplantation 1 suggests that systemic antibacterial prophylaxis not be used routinely for children receiving induction chemotherapy for newly diagnosed ALL, except in cases where the risk of bacteremia is high. Some key points to consider in the prevention of infectious complications in pediatric oncology patients include:
- Prophylactic antimicrobials, such as trimethoprim-sulfamethoxazole (5mg/kg/day divided twice daily) for Pneumocystis jirovecii pneumonia prevention during treatment and for 3-6 months after completion
- Antifungal prophylaxis with fluconazole (6-12mg/kg/day) for patients with prolonged neutropenia or receiving intensive regimens
- Acyclovir prophylaxis (10-20mg/kg/dose three times daily) for HSV-seropositive patients undergoing intensive therapy
- Vaccination schedules require modification, with live vaccines contraindicated during treatment
- Neutropenic precautions, including strict hand hygiene, avoiding raw foods, and prompt evaluation for fever (temperature ≥38.3°C once or ≥38.0°C for over an hour), which requires immediate assessment and broad-spectrum antibiotics like cefepime (50mg/kg/dose every 8 hours) or piperacillin-tazobactam (100mg/kg/dose every 6-8 hours). These interventions are critical because chemotherapy damages rapidly dividing cells, including bone marrow, resulting in neutropenia and compromised mucosal barriers, creating multiple pathways for infection that can rapidly become life-threatening in these vulnerable patients.
From the Research
Infectious Complications in Pediatric Oncology Patients
- Pediatric oncology patients are at risk for infectious complications due to intensive chemotherapy regimens resulting in prolonged immune suppression 2, 3.
- The use of total parenteral nutrition (TPN) in pediatric oncology patients has been associated with high infection rates and metabolic problems 2.
- Infection rates are a significant concern in pediatric oncology patients, and strategies to prevent and manage infections are crucial 3.
Prevention and Management of Infections
- Trimethoprim-sulfamethoxazole (TMP-SMX) is an effective treatment for Pneumocystis jirovecii pneumonia (PCP) in immunocompromised patients 4, 5, 6.
- Low-dose TMP-SMX has been shown to be effective in treating PCP with reduced adverse events compared to conventional-dose TMP-SMX 4, 5, 6.
- The optimization of TMP-SMX dosing strategies is essential to ensure the safety and efficacy of treatment for PCP in immunocompromised patients 6.
Supportive Care in Pediatric Oncology
- Pediatric intensive care units (PICU) provide essential services to support pediatric oncology patients 3.
- The outcome of pediatric oncology patients admitted to the PICU has improved over the years, with factors such as early admission, low PRISM score, and minimal organ failure associated with better outcomes 3.
- Specific scoring systems for early identification of children with cancer needing PICU treatment are required to further improve PICU outcome in critically ill pediatric cancer patients 3.