Infection-related complications remain the leading cause of treatment failure and mortality in pediatric oncology in low- and middle-income countries (LMICs). While antibacterial prophylaxis is widely used in high-income settings, its implementation in LMICs is limited by antimicrobial resistance (AMR) concerns and constrained health-system capacity. Using the Donabedian Model of Quality of Care, we evaluated whether optimizing a modifiable clinical process could mitigate structural barriers and improve outcomes in children receiving intensive chemotherapy. To assess the effectiveness and safety of prophylactic levofloxacin in reducing febrile neutropenia (FN) and infection-related health-system burden in pediatric oncology patients. In this prospective, open-label randomized controlled trial, children aged 1–14 years with hematological malignancies or solid tumors (N=90) undergoing intensive chemotherapy were randomized (1:1) to receive oral levofloxacin (10 mg/kg/dose twice daily) during anticipated neutropenia (ANC

Dr. Hijab Shaheen is a Senior Medical Officer in the Pediatric Oncology Department at Children Hospital, Pakistan Institute of Medical Sciences (PIMS), Islamabad. She holds FCPS in Pediatric Oncology and Hematology (2024) and FCPS in Pediatrics (2018). She has extensive clinical experience in pediatric oncology, infectious diseases, neonatology, and intensive care. Dr. Shaheen has authored multiple peer-reviewed publications on pediatric oncology, chemotherapy-related adverse effects, nutrition, and supportive care. She is an active member of national and international pediatric oncology societies and regularly contributes to academic conferences and research capacity-building initiatives.