Antibacterial |
Ciprofloxacin 500 or 750 mg orally twice daily |
Levofloxacin 500 or 750 mg orally once daily |
Antifungal |
Fluconazole¶ 200 or 400 mg orally once daily |
Posaconazole¶ delayed-release tablets 300 mg (three 100 mg tablets) orally every 12 hours on the first day, followed by 300 mg (three 100 mg tablets) once daily starting on the second day |
Voriconazole¶ 200 mg orally twice daily |
Antiviral |
HSV and VZV |
Acyclovir
|
Valacyclovir 500 mg orally twice daily |
Famciclovir 250 mg orally twice daily |
CMVΔ |
Valganciclovir 900 mg orally once daily with food |
Ganciclovir 5 mg/kg IV once daily |
Pneumocystis |
Preferred regimen: |
Trimethoprim-sulfamethoxazole one single-strength tablet orally once daily or one double-strength tablet orally once daily or three times weekly◊ |
Alternative regimens: |
Dapsone 100 mg orally once daily or 50 mg orally twice daily |
Pentamidine 300 mg by aerosol every four weeks |
Atovaquone 1500 mg orally once daily with a high-fat meal |
CMV: cytomegalovirus; HSV: herpes simplex virus; IV: intravenously; VZV: varicella-zoster virus.
* Refer to the associated topic review for indications for antimicrobial prophylaxis.
¶ Posaconazole and voriconazole are potent inhibitors of CYP3A4 drug metabolism; fluconazole is a moderate inhibitor. Adjustment of antineoplastic therapy may be required. Readers may use the drug interactions program included with UpToDate to determine specific interactions.
Δ Regular cytomegalovirus (CMV) surveillance testing followed by preemptive anti-CMV therapy for a positive result may be preferred over prophylaxis and is discussed in the topic review on prevention of infections in patients with CLL, section on alemtuzumab. Note that the dosing and schedule for preemptive anti-CMV therapy differs from the prophylaxis dosing shown in this table.
◊ Trimethoprim-sulfamethoxazole is preferred as it is the most effective regimen for Pneumocystis prophylaxis. It also provides activity against Toxoplasma gondii as well as certain bacteria (Nocardia spp, Listeria spp, some pneumococci).Do you want to add Medilib to your home screen?