What prophylactic antimicrobial agents would you consider for an AML patient with history of levaquin resistant strep mitis?

First, confirm the prior isolate and susceptibility pattern to distinguish resistance to levofloxacin from broader fluoroquinolone resistance and look at β-lactam/vancomycin susceptibility. Individual prior microbiology and local antibiograms should strongly influence the choice. Cefpodoxime is a commonly used alternative to fluoroquinolone prophylaxis. However, caution is warranted, and susceptibility of the patient's previous isolate should be reviewed.