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

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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.

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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

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Correspondence to Jessica E Morgan.

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Morgan, J.E., Hassan, H., Cockle, J.V. et al. Critical review of current clinical practice guidelines for antifungal therapy in paediatric haematology and oncology. Support Care Cancer 25, 221–228 (2017). https://doi.org/10.1007/s00520-016-3412-y

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  • DOI: https://doi.org/10.1007/s00520-016-3412-y

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