Summary of Antimicrobial Prophylaxis for SCT

In general this table applies to patients who have stable engraftment and are near to discharge from hospital. By definition neutrophils are more than 0.5 x 109/L.


About this Canterbury DHB document (10217):
Document Owner:	Andrew Butler (see Who's Who)
Last Reviewed:	May 2021
Next Review:	May 2023
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Note: Only the electronic version is controlled. Once printed, this is no longer a controlled document. Disclaimer The Haematology Department Protocols and Guidelines (the Red Book) are intended as a guide for registered health professionals to communicate guidelines and share best practices with supporting health professionals within New Zealand district health boards. They are not intended to be provided to or used as a reference for patients or non-registered health professionals. All health professionals must exercise their own clinical judgement and use pertinent clinical data when treating patients. The authors and editors of this publication have checked with sources believed to be reliable in their effort to provide information that is complete and in accord with the standards accepted at the time of publication. However, in view of the possibility of human error or changes in medical science, neither the authors, editors, publisher, nor any other party who has been involved in preparing or publishing this work warrants that the information contained in it is accurate or complete in every respect. They therefore have no liability (whether in tort (including negligence) or otherwise) for any loss or damage arising out of any reliance on this information. This publication has been compiled by the staff and contractors of Canterbury District Health Board (CDHB) and as such CDHB has copyright for this book. Amendments must be authorised in accordance with the documented process. No release of part of, or all of, this publication to any other party or organisation is permissible without the prior approval of the designated document owner.
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Type	Autologous	Allogeneic – no GvHD	Allogeneic with GvHD
Bacterial	None.	Phenoxymethylpenicillin 500 mg BD PO for approximately 13 months.	Phenoxymethylpenicillin 500 mg BD PO for 18 months, or longer if GvHD persists.
Fungal	Fluconazole.	Fluconazole.	Posaconazole 300 mg PO BD for day 1 (omit if transferring directly from the oral liquid) then 300 mg PO ONCE daily.
Herpes Simplex	Past problems with HSV and/or is HSV seropositive – valaciclovir 500mg ONCE daily PO for one month post-SCT.	Past problems with HSV and/or is HSV seropositive – valaciclovir 500mg ONCE daily PO for one month post-SCT.	Past problems with HSV and/or is HSV seropositive – valaciclovir 500mg ONCE daily PO.
Herpes Zoster	If the patient is VZV seropositive, give valaciclovir 500mg BD PO for 12 months post-SCT.	If the patient is VZV seropositive, give valaciclovir 500mg BD PO for 12 months.	If the patient is VZV seropositive, give valaciclovir 500mg BD PO for 12 months, or for longer if GvHD persists.
Pneumocystis	trimethoprim + sulfamethoxazole 80 + 400 mg PO ONCE daily for six months post-transplant starting following stable engraftment.	trimethoprim + sulfamethoxazole 80 + 400mg PO ONCE daily for 12 months post-transplant starting following stable engraftment.	trimethoprim + sulfamethoxazole 80 + 400mg PO ONCE daily for six months post-transplant starting following stable engraftment, or for longer if GvHD persists.
CMV	This depends on the CMV serological status of the patient (and donor if relevant) as well as the type of SCT carried out. See CMV prophylaxis.