Infection Prophylaxis For Patients With Neutropenia

AML patients treated with chemotherapy are expected to experience periods of neutropenia. The risk of infection associated with neutropenia is influenced by various factors such as prior healthcare exposure, the length of neutropenia, the degree of neutropenia and characteristics of disease.

Most AML patients receiving intensive chemotherapy should receive prophylaxis for HSV/VZV, bacterial pathogens and fungal pathogens. Our standard prophylaxis is:

• Acyclovir 800mg PO BID
• Levofloxacin 500mg PO Daily
• Posaconazole 300mg PO Daily or Voriconazole 300mg PO BID

Note that posaconazole can represent a significant cost burden to many patients. There is some data for its superiority, however voriconazole is a reasonable substitute.

How to take medications for infection prophylaxis

These agents can cause some update stomach. Levofloxacin which should not be coadministered with things like Maalox or Tums (separate by at least 2 hours). Famotidine would be OK with levofloxacin.

Otherwise, there are no interactions with Maalox, Tums, or famotidine and posaconazole or acyclovir. Patients can try taking the pills with a small snack or meal which can help with upset stomach associated with pills. If she wants to use Maalox or Tums, I would suggest taking ACV and posa in the AM with Tums/Maalox, then taking levofloxacin in the evening WITHOUT Tums/maalox (hopefully the levo doesn't cause upset stomach by itself).