{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T16:17:33Z","timestamp":1787761053186,"version":"build-2784847793"},"reference-count":16,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T00:00:00Z","timestamp":1784764800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T00:00:00Z","timestamp":1784764800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100012524","name":"American Lebanese Syrian Associated Charities","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100012524","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Blood &amp; Cancer"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Prophylactic administration of oral third\u2010generation cephalosporins, administered prior to and concurrently with irinotecan, reduces dose\u2010limiting diarrhea and allows higher irinotecan dosing in pediatric patients. The Children's Oncology Group recommends a 10\u2010day cefixime regimen, beginning 2 days prior to irinotecan, continuing throughout the 5\u2010day irinotecan course, and concluding 3 days afterward. Despite its efficacy, compliance with this regimen presents significant logistical challenges. To address these challenges, a multidisciplinary team at St. Jude Children's Research Hospital instituted a standardized 5\u2010day prophylactic regimen in patients receiving irinotecan. This study compared the incidence of severe diarrhea during the first course of irinotecan before and after the implementation of a shortened 5\u2010day course of cefixime.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Procedure<\/jats:title>\n                    <jats:p>\n                      A single\u2010center retrospective cohort study was performed for patients who received a 5\u2010day course of irinotecan during the 12 months before and 18 months after implementation of a shortened cefixime prophylaxis regimen. The primary outcome was the incidence of severe diarrhea. Secondary outcomes included provider ordering compliance with prophylactic antibiotic recommendations, the duration of prophylactic antibiotics, and the incidence of\n                      <jats:italic>Clostridioides difficile<\/jats:italic>\n                      infections or ceftriaxone\u2010resistant gram\u2010negative bacterial infections.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Data were collected for 85 participants (35 pre\u2010implementation and 50 in the post\u2010implementation period), representing a total of 432 irinotecan courses. Eighty\u2010two percent of courses included intravenous irinotecan. The incidence of severe diarrhea was 5.4% in the pre\u2010 and 6.2% in the post\u2010implementation period (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.7255). Provider ordering compliance with the institutional standard improved from 7.2% to 68.4% (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.0001). Three patients developed a\n                      <jats:italic>C. difficile<\/jats:italic>\n                      infection, while no patients developed a microbiologically documented ceftriaxone\u2010resistant gram\u2010negative bacterial infection.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>A 5\u2010day course of prophylactic cefixime, starting on the day of irinotecan initiation, was safe, increased provider ordering compliance, and did not lead to increased irinotecan toxicity.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/1545-5017.70514","type":"journal-article","created":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T22:09:27Z","timestamp":1784844567000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Short Course Cefixime to Prevent Irinotecan\u2010Associated Diarrhea in Children With Solid Tumors: A Retrospective Analysis"],"prefix":"10.1002","volume":"73","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-4408-3245","authenticated-orcid":false,"given":"Megan R.","family":"Wright","sequence":"first","affiliation":[{"name":"Department of Pharmacy and Pharmaceutical Sciences St. Jude Children's Research Hospital  Memphis Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shane J.","family":"Cross","sequence":"additional","affiliation":[{"name":"Department of Pharmacy and Pharmaceutical Sciences St. Jude Children's Research Hospital  Memphis Tennessee USA"},{"name":"University of Tennessee Health Science Center College of Pharmacy  Memphis Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ted","family":"Morton","sequence":"additional","affiliation":[{"name":"Department of Pharmacy and Pharmaceutical Sciences St. Jude Children's Research Hospital  Memphis Tennessee USA"},{"name":"University of Tennessee Health Science Center College of Pharmacy  Memphis Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen","family":"Hall","sequence":"additional","affiliation":[{"name":"Department of Pharmacy and Pharmaceutical Sciences St. Jude Children's Research Hospital  Memphis Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4741-6102","authenticated-orcid":false,"given":"Melissa S.","family":"Bourque","sequence":"additional","affiliation":[{"name":"Department of Pharmacy and Pharmaceutical Sciences St. Jude Children's Research Hospital  Memphis Tennessee USA"},{"name":"University of Tennessee Health Science Center College of Pharmacy  Memphis Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9912-3646","authenticated-orcid":false,"given":"Josh","family":"Wolf","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases St. Jude Children's Research Hospital  Memphis Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yin","family":"Su","sequence":"additional","affiliation":[{"name":"Department of Quantitative Health Sciences Cleveland Clinic  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li","family":"Tang","sequence":"additional","affiliation":[{"name":"Department of Quantitative Health Sciences Cleveland Clinic  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristine","family":"Crews","sequence":"additional","affiliation":[{"name":"Department of Pharmacy and Pharmaceutical Sciences St. Jude Children's Research Hospital  Memphis Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1722-2924","authenticated-orcid":false,"given":"Jessica","family":"Gartrell","sequence":"additional","affiliation":[{"name":"Department of Oncology St. Jude Children's Research Hospital  Memphis Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathryn P.","family":"Goggin","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Emory University and Children's Healthcare of Atlanta  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony M.","family":"Christensen","sequence":"additional","affiliation":[{"name":"Department of Pharmacy and Pharmaceutical Sciences St. Jude Children's Research Hospital  Memphis Tennessee USA"},{"name":"University of Tennessee Health Science Center College of Pharmacy  Memphis Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,23]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(24)00255-9"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.29282"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1080\/0284186X.2018.1449250"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.critrevonc.2021.103457"},{"key":"e_1_2_9_6_1","unstructured":"Irinotecan [Package Insert].2022:Andhra Pradesh India."},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2005.03.2847"},{"issue":"17","key":"e_1_2_9_8_1","first-page":"4725","article-title":"Proficient Metabolism of Irinotecan by a Human Intestinal Carboxylesterase","volume":"60","author":"Khanna R.","year":"2000","journal-title":"Cancer 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Cancer"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/1545-5017.70514","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/1545-5017.70514","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/1545-5017.70514","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T15:17:46Z","timestamp":1787757466000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/1545-5017.70514"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,23]]},"references-count":16,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2026,9]]}},"alternative-id":["10.1002\/1545-5017.70514"],"URL":"https:\/\/doi.org\/10.1002\/1545-5017.70514","archive":["Portico"],"relation":{},"ISSN":["1545-5009","1545-5017"],"issn-type":[{"value":"1545-5009","type":"print"},{"value":"1545-5017","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,23]]},"assertion":[{"value":"2026-04-20","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication 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