Management of infection in children with malignancy

The outcome for children with cancer has improved significantly over the last 20 years. This has been achieved by the use of combination chemotherapy, radiotherapy, surgery and haemopoietic stem cell transplant strategies. Simultaneous improvement in supportive care has also greatly contributed. Control of infection, in particular, has improved immensely and is the particular topic of this Update. Infection is still one of the most serious complications for the immunocompromised host. Most patients with malignancy become neutropenic at some point during treatment. Many patients will also have other causes of immunodeficiency, with impairment of both cellular and humoral immunity putting them at increased risk of infection from bacterial, fungal and viral pathogens. Infections, especially with gram-negative bacilli, in the immunocompromised host may result in the rapid onset of septic shock which, without rapid and appropriate antibiotic therapy, is life-threatening [1]. Therefore, the challenge in modern antibicrobial management is prompt diagnosis and identification of the infecting organism followed by rapid institution of appropriate therapy with as few, or safely managed, side-effects as possible. This goal can be achieved by using antibacterial, antiviral and antifungal agents alone or in combination with cytokine therapy to accelerate neutrophil and macrophage recovery in some cases. In this review we aim to examine some of the recent progress in this field and its impact on clinical practice. Our view of ‘current standard best practice’ is summarised in Fig. 1. 2. Infections