Review: Levofloxacin Prophylaxis in Pediatric Oncology Patients

Purpose of review Bacterial sepsis is a leading cause of morbidity and mortality among pediatric cancer patients receiving intensive chemotherapy. While there are treatment guidelines for empiric antimicrobial therapy for fever with neutropenia, the role of prophylactic antibacterial agents has been widely debated and is less well-defined. Recent findings Demonstrable benefits of fluoroquinolone prophylaxis (specifically levofloxacin) include prevention of bacteremia and potentially fevers during neutropenia, though with limited if any impact on mortality. However, the risks of using antibacterial prophylaxis include antimicrobial over-utilization, antimicrobial resistance, Clostridioides difficile colitis, and stool dysbiosis with associated risk of graft versus host disease and mortality. Summary This review article outlines the current literature and provides guidance for decisions about levofloxacin prophylaxis in the pediatric oncology population.