Abstract
Mortality due to S.pneumoniae septicemia in infants and young children with sickle cell anemia (SCA) remains unacceptably high. Pneumococcal vaccine and prophylactic penicillin (PRO PCN) have been used to prevent these infections. We have routinely used PRO PCN since 1978 for all patients with homozygous SCA between 6 mo and 5 yr of age: 125 mg b.i.d. for infants <2 yrs of age and 250 mg b.i.d. for those >2 yr old. Compliance is maximized by means of regular reminders. 71 patients have received PRO PCN for a total of 204 person yrs. During the past 6 1/2 yrs, 7 episodes of S. pneumoniae bacteremia occurred in 6 children (3.4 episodes/100 person yrs); 3 events were fatal. S.pneumoniae infections occurred in 4 clinical settings: (1) A 6 yr old girl died of sepsis 13 months after we electively terminated 4 yrs of prophylaxis. (2) A 14 month old girl died of sepsis 2 weeks after her PCN prescription ran out and her parents failed to refill it. (3) After missing only 1 or 2 doses, a 4 yr old girl died and another patient survived 2 episodes of sepsis. (4) Bacteremic pneumococcal pneumonia developed within 12 hours of the last PCN dose in a 9 month old girl who was reported not to have missed any recent doses. No examples of PCN insensitive or resistant S. pneumoniae were seen. In conclusion, PRO PCN may reduce the frequency of S. pneumoniae sepsis, but strict compliance is required. Prolonged administration may be advisable, with the understanding that absolute protection is not achieved.
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Buchanan, G., Smith, S. 889 PNEUMOCOCCAL SEPTICEMIA DESPITE PENICILLIN PROPHYLAXIS IN CHILDREN WITH SICKLE CELL ANEMIA. Pediatr Res 19, 259 (1985). https://doi.org/10.1203/00006450-198504000-00919
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DOI: https://doi.org/10.1203/00006450-198504000-00919