Antimicrobial Drug Prophylaxis: Challenges and Controversies

Prevention of infection is important in the susceptible patients undergoing transplantation. Accurate diagnosis continues to be a challenge, and response to treatment is often suboptimal, mainly due to immune defects that cannot be corrected during the course of an infection episode. Antimicrobial drugs are the cornerstone for prevention of opportunistic and other routinely encountered infections in patients undergoing solid organ and hematopoietic stem cell allograft transplantation. However, there are many controversies associated with antimicrobial prophylaxis. In general, antimicrobial prophylaxis is beneficial during periods when the infection risk is highest including the early postoperative period in patients undergoing visceral allograft surgery and those with acute allograft rejection; in HSCT recipients with pre-engraftment neutropenia and those with graft-versus-host disease, to name a few. In a number of other situations, a clear benefit from such innervation is not certain. In this chapter, we present a comprehensive discussion on challenges and controversies associated with antimicrobial prophylaxis in HSCT and SOT recipients.