Recommendations for antibacterial prophylaxis in children receiving chemotherapy: a joint initiative of SITIP and infectious disease group of AIEOP

Background: Current guidelines for managing infections in pediatric patients with cancer do not recommend routine antibiotic prophylaxis (AP). However, several aspects of AP, including the role of diagnosis, the impact of neutropenia duration, screening for resistant bacterial colonization, and antibiotic stewardship, remain a matter of debate. Methods: To address these issues, a panel of experts from the Italian Association of Pediatric Hematology and Oncology (AIEOP) and the Italian Society of Pediatric Infectious Diseases (SITIP) conducted a Delphi consensus. A comprehensive literature review and a national survey of pediatric oncology centers identified clinically relevant topics that are not fully covered by current guidelines. Based on this, the expert panel developed and voted on 14 statements covering eight key areas: the role of diagnosis, duration of neutropenia, screening for colonization with antibiotic resistant bacteria, use of validated risk scores, implementation of antimicrobial stewardship programs, periodic monitoring of local epidemiology, choice of antibiotic for prophylaxis, and the risk of resistance following prophylaxis. Results: The panel reached a consensus against prophylaxis in patients receiving monoclonal antibody therapy and advised against using the duration of neutropenia alone as a criterion to initiate prophylaxis, recommending it only for severe neutropenia (< 500/mm³). They also emphasized the importance of screening for multidrug resistant bacteria and implementing antimicrobial stewardship supported by specialist consultation. Conclusions: These recommendations provide guidance for clinicians on the selective use of AP, supporting informed decision making while ensuring appropriate treatment and reducing the emergence of multidrug resistant bacterial infections.