Table 7.

Available options of prophylaxis to specific infections [117]

Infection	Prophylaxis regimen	Renal dose adjustment	Adverse reactions	Duration of prophylaxis and monitoring
Cytomegalovirus (CMV) [127, 128]	Valganciclovir PO  < 16 years old: Daily dose = 7 × BSA (m2) × eGFR; Max 450 mg for intermediate-risk transplant recipient (donor CMV +ve to recipient CMV +ve); and Max 900  mg for high-risk transplant recipient (donor CMV +ve to recipient CMV −ve)	eGFR < 60; paediatric formula has incorporated eGFR in dose calculation	Neutropenia, nausea, diarrhoea, anaemia, hypertension	High-risk transplant recipient: 6 months Intermediate-risk transplant recipient: 3 months
Herpes simplex virus (HSV) [75]	Prevention for recurrent infections Acyclovir 80 mg/kg/day in 2 to 3 divided doses PO, max 800 mg per dose	eGFR < 25	Acute kidney failure, neutropenia, anaemia, thrombocytopenia	Until at least 6 months after last rituximab infusion
	Prevention for recurrent infections Valacyclovir 20 mg/kg (max 500 mg) BD PO	eGFR < 30	Abdominal pain, nausea, headache, nasopharyngitis, acute kidney failure, neutropenia,
Hepatitis B [129]	HBV reactivation Entecavir  > 2 years old: 0.015 mg/kg (max 0.5 mg) daily PO	eGFR < 50	Increased transaminases, glycosuria, haematuria	Until 12–18 months after last rituximab infusion, followed by 12 months of close surveillance after cessation of prophylaxis
	Tenofovir disoproxil fumarate  > 2 years old: 8 mg/kg (max 300 mg) daily PO	eGFR < 50	Nephrotoxicity, decreased bone mineral density
	Tenofovir alafenamide  > 6 years old: 25 mg daily PO	eGFR < 30	Headache, increased transaminases
	Post-exposure in anti-HBs negative patients Hepatitis B hyperimmune globulin (HBIG) 0.06 mL/kg (max 5 mL) IM as soon as possible after exposure (within 24 h of needlestick, ocular or mucosal exposure) Consider giving a second dose of HBIG 4 weeks later (due to suboptimal vaccine response)	Not required	Headache, malaise, myalgia, pain at injection site, erythema	1–2 doses
Influenza A and B [130]	Post-exposure prophylaxis Oseltamivir 10–15 kg: 30 mg daily  > 15–23 kg: 45 mg daily  > 23–40 kg: 60 mg daily  > 40 kg: 75 mg daily	eGFR < 60	Nausea, vomiting, headache, skin reactions	7 days
	Inhaled zanamivir  > 5 years old: 10 mg (two 5 mg inhalation) daily	Not required	Bronchospasm, skin reactions	7 days
Pneumocystis jirovecii [131]	Trimethoprim-sulfamethoxazole (TMP-SMX)/cotrimoxazole (suggested) 2.5–5 mg/kg (max 160 mg) TMP daily or 3 times per week PO	eGFR < 30	Hypersensitivity reactions (rashes, fever), neutropenia, hyperkalaemia, increased transaminases, kidney failure	Until at least 6 months after last rituximab infusion, or until B-cell reconstitution, whichever longer
	Inhaled pentamidine (> 5 years old) 300 mg every month, with nebulised salbutamol as pre-medication IV pentamidine  > 2 years old: 4 mg/kg (max 300 mg) every 4 weeks	Not required	Nephrotoxicity, hyper or hypokalaemia, hypoglycaemia, hypocalcaemia, arrhythmias, pancreatitis, respiratory symptoms
	Dapsone 2 mg/kg (max 100 mg) daily or 4 mg/kg (max 200 mg) weekly PO	Not required	Rash, fever, lymphadenopathy, haemolytic anaemia, increased transaminases, methemoglobinemia, neutropenia
	Atovaquone  > 2 years old: 30 mg/kg (max 1500 mg) daily PO	Not required	Nausea, diarrhoea, fever, hepatitis, rash
Tuberculosis [132]	Reactivation of latent infection (1) Isoniazid monotherapy for 6 or 9 months 10–20 mg/kg (children), 5 mg/kg (adult) (max 300 mg) daily PO (2) Isoniazid and rifapentine combination therapy for 3 months Isoniazid 2–11 years old: 25 mg/kg (max 900 mg) once weekly PO  > 12 years old: 15 mg/kg (max 900 mg) once weekly PO Rifapentine (10–14 kg) 300 mg once weekly PO (14.1–25 kg) 450 mg once weekly PO (25.1–32 kg) 600 mg once weekly PO (32.1–49.9 kg) 750 mg once weekly PO  > 50 kg 900 mg once weekly PO (3) Rifampicin monotherapy for 4 months 15–20 mg/kg (children) or 10 mg/kg (adult) (max 600 mg) daily PO (4) Isoniazid and rifampicin combination therapy for 3 months Isoniazid 10–20 mg/kg (children), 5 mg/kg (adult) (max 300 mg) daily PO Rifampicin 15–20 mg/kg (children) or 10 mg/kg (adult) (max 600 mg) daily PO	Not required	Isoniazid Peripheral neuropathy, hepatotoxicity, rash, hypersensitivity Rifapentine Anaemia, thrombocytopenia, neutropenia Rifampicin Hepatotoxicity, rash or other allergy, thrombocytopenia, gastrointestinal upset	Duration varies with the regimen (as mentioned)
Varicella zoster virus (VZV) [133]	Post-exposure prophylaxis Acyclovir 20 mg/kg/dose four times a day (max 800 mg per dose) for 7 days PO, beginning 7 days after exposure	eGFR < 25	Acute kidney failure, neutropenia, anaemia, thrombocytopenia	7 days
	Post-exposure prophylaxis Varicella immunoglobulin IM injection (VARIZIG®) 125 IU/10 kg body weight, up to a maximum of 625 IU, ideally within 96 h but can be given up to 10 days after exposure	Not required	Pain at injection site, skin rash	1 dose