Critical review of current clinical practice guidelines for antifungal therapy in paediatric haematology and oncology
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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), 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.
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.
KeywordsFungal 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.
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