Antibiotic prevention of pneumococcal infections in asplenic hosts: admission of insufficiency.
Asplenic and hyposplenic patients have an increased risk for overwhelming pneumococcal infections, even several decades after splenectomy. Pneumococcal vaccination and daily oral administration of penicillin V are recommended to prevent such infections, 2-5 years after splenectomy, and for at least 5 years in children affected with sickle cell disease. In order to assess whether the infectious risk is actually known and prevented, we interviewed physicians (belonging to a general practitioner and pediatrician network) who followed patients having undergone a splenectomy and/or children with sickle cell disease under 5 years of age. We received replies from 104 physicians monitoring 152 patients replied. Potential infection risk was not known for 28% of the asplenic patients and 40% of the children with sickle cell disease. Only 75% of the asplenic patients and 36% of the children with sickle cell disease had been vaccinated against pneumococcus. Of the patients who had undergone splenectomy, 27% had been treated with an antibiotic after surgery and 60% had discontinued it, the vast majority of them during the same year. Of the children with sickle cell disease, 48% were not receiving an antibiotic. This study demonstrates that risk of infections in asplenic patients is widely misunderstood, indicating the urgent need to improve their management.
de Montalembert
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Service de Pédiatrie Générale, Hôpital Necker-Enfants Malades, 149 rue de Sèvres, 75015 Paris, France. mariane.demontal@nck.ap-hop-paris.fr
Lenoir
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G
D000293:Adolescent; D000755:Anemia, Sickle Cell / Q000150:complications / Q000188:drug therapy; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D005500:Follow-Up Studies; D006801:Humans; D007407:Interviews as Topic; D011008:Pneumococcal Infections / Q000209:etiology / Q000517:prevention & control*; D012189:Retrospective Studies; D012307:Risk Factors; D013156:Splenectomy / Q000009:adverse effects*; D014611:Vaccination
D000900:Anti-Bacterial Agents