Karamvir Yadav, Medical Oncologist at Harish Renova Hospital, shared on X:
“Antimicrobial prophylaxis in pediatric cancer: what changed in the 2026 update?
The JCO 2026 guideline update reinforces a risk – adapted approach rather than routine prophylaxis.
Antibacterial
- Consider in AML and relapsed ALL with prolonged severe neutropenia
- Levofloxacin remains preferred
- If levofloxacin cannot be used – consider NO antibacterial prophylaxis
- Major concern: antimicrobial resistance
Antifungal
- Strongly recommended in AML with prolonged severe neutropenia
- Allogeneic HCT: pre-engraftment and during GVHD immunosuppression
- Echinocandin or mold – active azole preferred
- Avoid routine prophylaxis in low – risk ALL, most lymphoma solid tumors and autologous HCT
Key message: Target prophylaxis to patients most likely to benefit – and incorporate local resistance patterns, drug interactions and infection epidemiology.”
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