Abstract
In children with cancer, chemotherapy can produce cytotoxic effects, resulting in immunosuppression and an augmented risk of febrile neutropenia and bloodstream infections. This has led to widespread use of antibiotic prophylaxis which, combined with intensive chemotherapy treatment, could have a long-term effect on the gastrointestinal microbiome. In this review, we aimed to analyze the current literature about the widespread use of antibiotic prophylaxis in children experiencing infectious complications induced by chemotherapy and its effects on the gut microbiome. Our review of the literature shows that antimicrobial prophylaxis in children with cancer is still a trending topic and, at the moment, there are not enough data to define universal guidelines. Children with cancer experience long and painful medical treatments and side effects, which are associated with great economic and social burdens, important psychological consequences, and dysbiosis induced by antibiotics and also by chemotherapy. Considering the importance of a healthy gut microbiota, studies are needed to understand the impact of dysbiosis in response to therapy in these children and to define how to modulate the microbiome to favor a positive therapeutic outcome.
Highlights
The epidemiology of cancer in children differs from that in adulthood: lymphohematopoietic cancers account for approximately 40%, central nervous system (CNS) cancers account for approximately 30%, and embryonal tumors and sarcomas account for approximately 10% of cases
We aimed to analyze the current literature about the widespread use of antibiotic prophylaxis in children experiencing infectious complications induced by chemotherapy and its effects on the gut microbiome
Our review of the literature shows that antimicrobial prophylaxis in children with cancer is still a trending topic and, at the moment, there are not enough data to define universal guidelines
Summary
Cancer diagnoses in patients younger than 20 years old are rare, representing only approximately 1% of all new cancer cases every year, and the survival rate increased to. The use of some chemotherapeutics can produce cytotoxic effects, resulting in immunosuppression and an augmented risk of febrile neutropenia (i.e., the total number of blood neutrophils ≤ 500/mm3 ) and bloodstream infections [2] This has led to widespread use of antibiotic prophylaxis, which, combined with intensive chemotherapy treatment, could have a long-term effect on the gastrointestinal microbiome [3]. The effects of this alteration have been studied but remain mostly unknown; it has been proven that this change leads to colonization by opportunistic pathogens, impairs the gastrointestinal barrier, increases vulnerability to Clostridium difficile infections [3], and is linked to the development of a variety of diseases. More than 150 articles were found, but only those written in English were taken into consideration
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