Clinical Practice Guideline for Systemic Antibacterial and Antifungal Prophylaxis in Pediatric Patients With Cancer and Hematopoietic Cell Transplant Recipients: 2026 Update
Abstract
PURPOSE
To provide updated Pediatric Oncology Group of Ontario clinical practice guidelines (CPGs) for systemic antibacterial and antifungal prophylaxis in pediatric patients with cancer and hematopoietic cell transplantation (HCT) recipients.
METHODS
In this update, we harmonized procedures and recommendations across both the antibacterial and antifungal CPGs. Systematic reviews of randomized clinical trials evaluating systemic antibacterial and antifungal prophylaxis in pediatric and adult patients with cancer and HCT recipients were updated. Using the Grading of Recommendations Assessment, Development and Evaluation approach, an international multidisciplinary panel revised or formulated recommendations and classified evidence quality. Good practice statements were also created.
RESULTS
The updated search identified 13 new randomized trials published since 2019 (eight antibacterial and five antifungal), resulting in 195 total trials. The panel maintained a conditional recommendation to consider antibacterial prophylaxis in pediatric patients with AML and relapsed ALL and a strong recommendation to use levofloxacin when antibacterial prophylaxis is planned. A new conditional recommendation was introduced to consider using no antibacterial prophylaxis in patients unable to receive levofloxacin. Strong recommendations to use antifungal prophylaxis in pediatric patients with AML and allogeneic HCT recipients and to use an echinocandin or a mold-active azole when antifungal…
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