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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

Abstract

Purpose

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.

Methods

Electronic searches of MEDLINE, MEDLINE in-Process & Other non-Indexed Citations, the Guidelines International Network (GIN), guideline.gov 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.

Results

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.

Conclusions

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.

Keywords

Fungal infection Paediatric Guideline Critical review 

Abbreviations

AGIHO

Infectious Diseases Working Party

ALL

Acute lymphoblastic leukaemia

AML

Acute myeloid leukaemia

CPGs

Clinical practice guidelines

DGHO

German Society of Hematology and Oncology

ECIL-4

Fourth European Conference on Infections in Leukaemia

ECMM

European Confederation of Medical Mycology

EORTC/MSG

European Organisation for Research and Treatment of Cancer Mycoses Study Group

ESCMID

European Society of Clinical Microbiology and Infectious Diseases

GIN

Guidelines International Network

GITMO

Gruppo Italiano Trapianto Midollo Osseo

HSCT

Haematopoietic stem cell transplant

IDSA

Infectious Diseases Society of America

IFD

Invasive fungal disease

IOM

Institute of Medicine

SEIMC

Spanish Society of Infectious Diseases and Clinical Microbiology

SIGN

Scottish Intercollegiate Guidelines Network

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

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520_2016_3412_MOESM2_ESM.docx (36 kb)
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References

  1. 1.
    McNeil MM, Nash SL, Hajjeh RA, et al. (2001) Trends in mortality due to invasive Mycotic diseases in the United States, 1980–1997. Clin Infect Dis 33:641–647. doi: 10.1086/322606 CrossRefPubMedGoogle Scholar
  2. 2.
    Lehrnbecher T, Phillips R, Alexander S, et al. (2012) Guideline for the management of fever and neutropenia in children with cancer and/or undergoing hematopoietic stem-cell transplantation. J Clin Oncol 30:4427–4438. doi: 10.1200/JCO.2012.42.7161 CrossRefPubMedGoogle Scholar
  3. 3.
    Burgos A, Zaoutis TE, Dvorak CC, et al. (2008) Pediatric invasive aspergillosis: a multicenter retrospective analysis of 139 contemporary cases. Pediatrics 121:e1286–e1294. doi: 10.1542/peds.2007-2117 CrossRefPubMedGoogle Scholar
  4. 4.
    Groll AH, Kurz M, Schneider W, et al. (1999) Five-year-survey of invasive aspergillosis in a paediatric cancer centre. Epidemiology, management and long-term survival. Mycoses 42:431–442. doi: 10.1046/j.1439-0507.1999.00496.x CrossRefPubMedGoogle Scholar
  5. 5.
    Abbasi S, Shenep JL, Hughes WT, Flynn PM (1999) Aspergillosis in children with cancer: a 34-year experience. Clin Infect Dis 29:1210–1219. doi: 10.1086/313445 CrossRefPubMedGoogle Scholar
  6. 6.
    Lehrnbecher T, Ethier M-C, Zaoutis T, et al. (2009) International variations in infection supportive care practices for paediatric patients with acute myeloid leukaemia. Br J Haematol 147:125–128. doi: 10.1111/j.1365-2141.2009.07844.x CrossRefPubMedGoogle Scholar
  7. 7.
    Dvorak CC, Fisher BT, Sung L, et al. (2012) Antifungal prophylaxis in pediatric hematology/oncology: new choices & new data. Pediatr Blood Cancer 59:21–26. doi: 10.1002/pbc.23415 CrossRefPubMedGoogle Scholar
  8. 8.
    Brouwers MC, Kho ME, Browman GP, et al. (2010) AGREE II: advancing guideline development, reporting and evaluation in health care. Can Med Assoc J 182:E839–E842. doi: 10.1503/cmaj.090449 CrossRefGoogle Scholar
  9. 9.
    Pappas PG, Kauffman CA, Andes D, et al. (2009) Clinical practice guidelines for the Management of Candidiasis: 2009 update by the Infectious Diseases Society of America. Clin Infect Dis 48:503–535. doi: 10.1086/596757 CrossRefPubMedGoogle Scholar
  10. 10.
    Hope WW, Castagnola E, Groll AH, et al. (2012) ESCMID guideline for the diagnosis and management of Candida diseases 2012: prevention and management of invasive infections in neonates and children caused by Candida spp. Clin Microbiol Infect 18:38–52. doi: 10.1111/1469-0691.12040 CrossRefPubMedGoogle Scholar
  11. 11.
    Groll AH, Castagnola E, Cesaro S, et al. (2014) Fourth European conference on infections in leukaemia (ECIL-4): guidelines for diagnosis, prevention, and treatment of invasive fungal diseases in paediatric patients with cancer or allogeneic haemopoietic stem-cell transplantation. Lancet Oncol 15:e327–e340. doi: 10.1016/S1470-2045(14)70017-8 CrossRefPubMedGoogle Scholar
  12. 12.
    Marr KA, Bow E, Chiller T, et al. (2009) Fungal infection prevention after hematopoietic cell transplantation. Bone Marrow Transplant 44:483–487. doi: 10.1038/bmt.2009.259 CrossRefPubMedGoogle Scholar
  13. 13.
    Science M, Robinson PD, MacDonald T, et al. (2014) Guideline for primary antifungal prophylaxis for pediatric patients with cancer or hematopoietic stem cell transplant recipients. Pediatr Blood Cancer 61:393–400CrossRefPubMedGoogle Scholar
  14. 14.
    Ruiz-Camps I, Aguado JM, Almirante B, et al. (2011) Guidelines for the prevention of invasive mould diseases caused by filamentous fungi by the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC. Clin Microbiol Infect 17:1–24. doi: 10.1111/j.1469-0691.2011.03477.x CrossRefPubMedGoogle Scholar
  15. 15.
    Infectious Diseases Society of Taiwan, Hematology Society of Taiwan, Taiwan Society of Pulmonary and Critical Care Medicine, et al (2010) Guidelines for the use of antifungal agents in patients with invasive fungal infections in Taiwan-revised 2009. J Microbiol Immunol Infect 43:258–263CrossRefGoogle Scholar
  16. 16.
    Sullivan KM, Dykewicz CA, Longworth DL, et al. (2001) Preventing opportunistic infections after hematopoietic stem cell transplantation: the Centers for Disease Control and Prevention, Infectious Diseases Society of America, and American Society for Blood and Marrow Transplantation Practice Guidelines and beyond. Hematol Am Soc Hematol Educ Program:392–421Google Scholar
  17. 17.
    Cornely OA, Arikan-Akdagli S, Dannaoui E, et al (2014) ESCMID and ECMM joint clinical guidelines for the diagnosis and management of mucormycosis 2013. Clin Microbiol Infect Off Publ Eur Soc Clin Microbiol Infect Dis 20 Suppl 3:5–26.Google Scholar
  18. 18.
    Girmenia C, Barosi G, Piciocchi A, et al. (2014) Primary prophylaxis of invasive fungal diseases in allogeneic stem cell transplantation: revised recommendations from a consensus process by Gruppo Italiano Trapianto Midollo Osseo (GITMO). Biol Blood Marrow Transplant J Am Soc Blood Marrow Transplant 20:1080–1088CrossRefGoogle Scholar
  19. 19.
    Blyth CC, O’Brien TA, Palasanthiran P (2007) Australasian guidelines for antifungal therapy in neonates and children with proven, probable and suspected fungal infections. http://www.mycology.adelaide.edu.au/virtual/guidelines/. Accessed 11 Sep 2013
  20. 20.
    Mermel LA, Allon M, Bouza E, et al. (2009) Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 update by the Infectious Diseases Society of America. Clin Infect Dis 49:1–45CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Chapman SW, Dismukes WE, Proia LA, et al. (2008) Clinical practice guidelines for the management of blastomycosis: 2008 update by the Infectious Diseases Society of America. Clin Infect Dis 46:1801–1812. doi: 10.1086/588300 CrossRefPubMedGoogle Scholar
  22. 22.
    Perfect JR, Dismukes WE, Dromer F, et al. (2010) Clinical practice guidelines for the management of cryptococcal disease: 2010 update by the Infectious Diseases Society of America. Clin Infect Dis 50:291–322. doi: 10.1086/649858 CrossRefPubMedGoogle Scholar
  23. 23.
    Wheat LJ, Freifeld AG, Kleiman MB, et al. (2007) Clinical practice guidelines for the management of patients with histoplasmosis: 2007 update by the Infectious Diseases Society of America. Clin Infect Dis 45:807–825. doi: 10.1086/521259 CrossRefPubMedGoogle Scholar
  24. 24.
    Kauffman CA, Bustamante B, Chapman SW, Pappas PG (2007) Clinical practice guidelines for the management of sporotrichosis: 2007 update by the Infectious Diseases Society of America. Clin Infect Dis 45:1255–1265. doi: 10.1086/522765 CrossRefPubMedGoogle Scholar
  25. 25.
    Ruhnke M, Rickerts V, Cornely OA, et al. (2011) Diagnosis and therapy of Candida infections: joint recommendations of the German speaking mycological society and the Paul-Ehrlich-Society for Chemotherapy. Mycoses 54:279–310. doi: 10.1111/j.1439-0507.2011.02040.x CrossRefPubMedGoogle Scholar
  26. 26.
    Chowdhary A, Meis JF, Guarro J, et al (2014) ESCMID and ECMM joint clinical guidelines for the diagnosis and management of systemic phaeohyphomycosis: diseases caused by black fungi. Clin Microbiol Infect Off Publ Eur Soc Clin Microbiol Infect Dis 20 Suppl 3:47–75.Google Scholar
  27. 27.
    Arendrup MC, Boekhout T, Akova M, et al (2014) ESCMID and ECMM joint clinical guidelines for the diagnosis and management of rare invasive yeast infections. Clin Microbiol Infect Off Publ Eur Soc Clin Microbiol Infect Dis 20 Suppl 3:76–98.Google Scholar
  28. 28.
    Jakes AD, Marec-Berard P, Phillips RS, Stark DP (2014) Critical review of clinical practice guidelines for fertility preservation in teenagers and young adults with cancer. J Adolesc Young Adult Oncol 3:144–152. doi: 10.1089/jayao.2014.0032 CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Rüping MJGT, Vehreschild JJ, Cornely OA (2008) Antifungal treatment strategies in high risk patients. Mycoses 51:46–51. doi: 10.1111/j.1439-0507.2008.01572.x CrossRefPubMedGoogle Scholar
  30. 30.
    Institute of Medicine (2011) Clinical practice guidelines We can trust. The National Academies Press, Washington, DCGoogle Scholar

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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