Prophylactic penicillin after 5 years of age in patients with sickle cell disease: a survey of sickle cell disease experts.

Abstract

BACKGROUND:

Since the publication of the Prophlyactic Penicillin Study II in 1995, the management of penicillin prophylaxis for children with sickle cell disease (SCD) after 5 years of age has been controversial. In this study, we sought to describe current practice patterns of pediatric hematologists related to cessation of penicillin prophylaxis for children with SCD after 5 years of age.

PROCEDURE:

We performed a cross-sectional, electronic survey of pediatric hematologists with expertise in SCD to examine practices regarding penicillin prophylaxis in children with SCD after 5 years of age. We also investigated factors potentially associated with continuation of penicillin prophylaxis using the Jonckheere-Terpstra test and Fisher's exact test.

RESULTS:

Of the 106 physicians surveyed from 76 centers, 84% completed the survey. Among respondents, 76% routinely recommended cessation of penicillin prophylaxis after 5 years of age. The practice of routinely continuing penicillin after 5 years of age was associated with decreased concern about antibiotic resistance in Streptococcus pneumoniae (P = 0.01), with the usage of prophylactic penicillin in mild SCD genotypes (sickle hemoglobin-C disease and sickle β(+) thalassemia, P = <0.001), and with increasing use of other preventive evaluations (e.g., MRI for silent stroke) in childhood (P = 0.05).

CONCLUSION:

Most pediatric hematologists with an SCD expertise recommend cessation of prophylactic penicillin after 5 years of age.

• Authors: Timothy L McCavit, Megan Gilbert, George R Buchanan
• Journal: Pediatric blood & cancer (Pediatr Blood Cancer) Vol. 60 Issue 6 Pg. 935-9 (Jun 2013) ISSN: 1545-5017 [Electronic] United States
• PMID: 23193095 (Publication Type: Journal Article, Research Support, N.I.H., Extramural)
• Copyright: Copyright © 2012 Wiley Periodicals, Inc.

Chemical References

• Penicillins

Topics

• Anemia, Sickle Cell (complications)
• Antibiotic Prophylaxis (statistics & numerical data)
• Child
• Child, Preschool
• Cross-Sectional Studies
• Humans
• Penicillins (therapeutic use)
• Physicians
• Pneumococcal Infections (complications, prevention & control)
• Practice Patterns, Physicians' (statistics & numerical data)