Category: Professional Posters
Purpose: Many pediatric cancer patients require fungal infection prophylaxis depending on their risk for developing an invasive fungal infection. While several national guidelines exist recommending fungal infection prophylaxis in cancer patients, no consensus recommendation for fungal infection prophylaxis in pediatric cancer patients exists. We attempt to use primary literature, current guidelines, and interdisciplinary coordination to establish an institutional standard for the use of antifungal agents to prevent invasive fungal infections in pediatric cancer practice.
Methods: Pharmacists and student pharmacists evaluated randomized controlled trials using Pubmed and Cochrane Cancer Network Register of Trials to assess primary literature. We also searched disease-specific Children’s Oncology Group cancer treatment protocols well as National Comprehensive Cancer Center (NCCN) guidelines and Infectious Disease Society of America (IDSA) guidelines, despite these guidelines lacking specific pediatric recommendations. Providers in the hematology/oncology unit of a children’s hospital were surveyed about antifungal prescribing preferences for standard and high risk acute lymphoblastic leukemia, acute myelogenous leukemia and high risk neuroblastoma before and after presentation of current literature recommendations.
Results: Eight providers completed the pre- and post-antifungal practice surveys. Based on their responses, consensus fungal prophylaxis was achieved in the pediatric cancer clinician group. Standardized orders for antifungal therapy were incorporated into electronic chemotherapy treatment plans for diseases as developed by consensus.
Conclusion: Fungal prophylaxis recommendations, while well-defined for adults with cancer, are lacking in pediatric cancer patients, leading institutions to create unique guidelines to prevent fungal infections. In addition to achieving a consensus for antifungal prescribing, it was also deemed a best practice to incorporate standardized orders into existing electronic chemotherapy treatment plans to aid in practice standardization. By incorporating our consensus into treatment plans we are using ISMP’s highest level of effectiveness to create forcing functions at the level of prescribing. This will reduce errors in prescribing and ensure our antifungal guidelines are upheld.