Supportive Care in Cancer

, Volume 25, Issue 1, pp 221–228 | Cite as

Critical review of current clinical practice guidelines for antifungal therapy in paediatric haematology and oncology

  • Jessica E Morgan
  • Hadeel Hassan
  • Julia V Cockle
  • Christopher Lethaby
  • Beki James
  • Robert S Phillips
Original Article



The incidence of invasive fungal disease (IFD) is rising, but its treatment in paediatric haematology and oncology patients is not yet standardised. This review aimed to critically appraise and analyse the clinical practice guidelines (CPGs) that are available for paediatric IFD.


Electronic searches of MEDLINE, MEDLINE in-Process & Other non-Indexed Citations, the Guidelines International Network (GIN), and Google were performed and combined fungal disease (Fung* OR antifung*OR Candida* OR Aspergill*) with prophylaxis or treatment (prophyl* OR therap* OR treatment). All guidelines were assessed using the AGREE II tool and recommendations relating to prophylaxis, empirical treatment and specific therapy were extracted.


Nineteen guidelines met the inclusion criteria. The AGREE II scores for the rigour of development domain ranged from 11 to 92 % with a median of 53 % (interquartile range 32–69 %). Fluconazole was recommended as antifungal prophylaxis in all nine of the included guidelines which recommended a specific drug. Liposomal amphotericin B was recommended in all five guidelines giving empirical therapy recommendations. Specific therapy recommendations were given for oral or genital candidiasis, invasive candida infection, invasive aspergillosis and other mould infections.


In many areas, recommendations were clear about appropriate practice but further clarity was required, particularly relating to the decision to discontinue empirical antifungal treatment, the relative benefits of empiric and pre-emptive strategies and risk stratification.

Future CPGs could consider working to published guideline production methodologies and sharing summaries of evidence appraisal to reduce duplication of effort, improving the quality and efficiency of CPGs in this area.


Fungal infection Paediatric Guideline Critical review 



Infectious Diseases Working Party


Acute lymphoblastic leukaemia


Acute myeloid leukaemia


Clinical practice guidelines


German Society of Hematology and Oncology


Fourth European Conference on Infections in Leukaemia


European Confederation of Medical Mycology


European Organisation for Research and Treatment of Cancer Mycoses Study Group


European Society of Clinical Microbiology and Infectious Diseases


Guidelines International Network


Gruppo Italiano Trapianto Midollo Osseo


Haematopoietic stem cell transplant


Infectious Diseases Society of America


Invasive fungal disease


Institute of Medicine


Spanish Society of Infectious Diseases and Clinical Microbiology


Scottish Intercollegiate Guidelines Network


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

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Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Jessica E Morgan
    • 1
    • 2
  • Hadeel Hassan
    • 2
  • Julia V Cockle
    • 2
  • Christopher Lethaby
    • 2
  • Beki James
    • 2
  • Robert S Phillips
    • 1
    • 2
  1. 1.Centre for Reviews and DisseminationUniversity of YorkYorkUK
  2. 2.Department of Paediatric Haematology and OncologyLeeds Teaching Hospitals NHS TrustLeedsUK

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