Trying to improve compliance with prophylactic penicillin therapy in children with sickle cell disease.
OBJECTIVE
To evaluate compliance with prophylactic penicillin therapy in sickle cell disease (SCD) in children.


METHODS
Forty-five children aged 37 +/- 19 (9-84) months [mean +/- s.d; range] with homozygous SCD were recruited. After a baseline period of 2 months the patients were randomized to either the intervention or non-intervention group. The intervention consisted of a slide show explaining the pathogenesis of sickle cell disease and its complications; weekly phone calls by the clinic social worker; and a calendar. Compliance was again evaluated after the 2 month intervention period and after a further 2 month monitoring period without intervention. Compliance was monitored using the Medication Event Monitoring System. At the end of the 6 months, parents in both groups completed a questionnaire the aims of which were to determine knowledge and understanding of sickle cell disease and previous experience with infection. Patient admissions to the hospital during the study were recorded.


RESULTS
Compliance during the 2 month baseline assessment was 66.0 +/- 32.5 (1.3-98.2)% and 69.3+25.4 (19.8-96.5)% in the intervention (n = 13) and non-intervention (n = 10) groups respectively (P = 0.79). During the next 2 months, compliance in the intervention group (n = 11) was 79.0 +/- 31.4 (11.0-100.0)% and in the non-intervention group (n = 9) was 66.0 +/- 20.2 (42.2-96.8)% (P = 0.297). In the final 2 month monitoring period compliance was 82.0 +/- 34.7 (3.8-100.0)% and 65.8 +/- 25.3 (25.0-98.2)% in the intervention (n = 7) and the non-intervention (n = 6) groups respectively (P = 0.366). No statistically significant differences were found when comparing compliance between the groups.


CONCLUSIONS
Compliance with prophylactic antibiotic therapy in children with sickle cell disease is highly variable and its evaluation is problematic.
Berkovitch
M
M
Division of Pediatrics, Assaf Harofeh Medical Center, Sackler School of Medicine, Tel-Aviv University, Israel.
Papadouris
D
D
Shaw
D
D
Onuaha
N
N
Dias
C
C
Olivieri
N F
NF
D000284:Administration, Oral; D000704:Analysis of Variance; D019072:Antibiotic Prophylaxis; D002648:Child; D002675:Child, Preschool; D006450:Hemoglobin SC Disease / Q000188:drug therapy*; D006801:Humans; D007223:Infant; D010349:Patient Compliance; D010406:Penicillins / Q000008:administration & dosage / Q000627:therapeutic use*
D010406:Penicillins