Pathogen: Bacterial infections during the first 100 days after HCT

Indication	First Choice	Alternatives
Prevention of bacterial infections for adult HCT patients with anticipated neutropenic periods of 7 days or more	A fluoroquinolone with antipseudomonal activity (ie, levofloxacin 500 mg once daily (BI) or ciprofloxacin 500 mg twice daily (BII)) •Start at the time of stem cell infusion and continue until recovery from neutropenia or initiation of empirical antibacterial therapy for febrile neutropenia; •Local epidemiological data regarding fluoroquinolone resistance patterns should be carefully considered before applying its prophylaxis (AIII). Closely monitor for emergence of fluoroquinolone resistance (AIII)	Azithromycin 250 mg once daily (CIII)
Prevention of bacterial infections among adult or adolescent HCT recipients with severe hypogammaglobulinemia (ie, serum IgG level <400 mg/dL)	IVIG, 500 mg/kg/week (CIII)∗, †	None
Prevention of bacterial infections among allogeneic pediatric HCT recipients with severe hypogammaglobulinemia (ie, serum IgG level <400 mg/dL)	IVIG, 400 mg/kg/month (CIII)∗, †	None

IVIG indicates intravenous immunoglobulin; HCT, hematopoietic cell transplantation.

^∗Persons with IgA deficiency should not receive standard immunoglobulin products (DIII). Researchers have reported that use of IgA-depleted immunoglobulin preparations can be used with caution among these persons 834, 835, 836.

^†Researchers propose checking serum IgG levels every 2 weeks among patients receiving IVIG replacement therapy.