[Antibiotic prophylaxis against bacterial infections in the hyposplenic and asplenic child].
RISK OF INFECTION IN SPLENECTOMIZED CHILDREN: Observations in cohorts of splenectomized patients have led to the conclusion that the risk of bacterial infection is highest among young children, particularly under the age of 2 years, within 2 years of splenectomy and in children with an associated disease.
According to the Holdsworth study conducted between 1952 and 1987, the rate of postoperative infection in splenectomized children under the age of 16 years is 4.4%, mortality reaching 2.2%. The risk of severe bacterial infection is also high in sickle-cell anemia children and is the leading cause of death in this age group.
Current guidelines concerning antibiotic prophylaxis in asplenic and hyposplenic children are based on several notions: not giving antibiotic prophylaxis is unacceptable due to the major vulnerability of these children to pneumococcal infection and the frequence of pneumococcal colonization in this age group; the antibiotic given should have a narrow spectrum.


CONCLUSIONS
Antibiotic prophylaxis against infection in asplenic and hyposplenic children is based on daily administration of Oracilline (Penicilline V). Prophylaxis is started at diagnosis in sickle-cell anemia children, i.e. around 2-3 months of age in case of neonatal screening. Oracilline should be given at least 5 years after splenectomy or even longer, and up to the age of 15 years in sickle-cell anemia children who develop frequent ENT/bronchial complications or have a history of pneumococcal infection.
de Montalembert
M
M
Service de pédiatrie Hôpital Necker-Enfants Malades, Paris (75).
D000293:Adolescent; D000367:Age Factors; D000755:Anemia, Sickle Cell / Q000150:complications / Q000188:drug therapy*; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D001424:Bacterial Infections / Q000209:etiology / Q000517:prevention & control*; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007231:Infant, Newborn; D010404:Penicillin V / Q000008:administration & dosage / Q000627:therapeutic use*; D017410:Practice Guidelines as Topic; D012307:Risk Factors; D013156:Splenectomy / Q000009:adverse effects; D013997:Time Factors
D000900:Anti-Bacterial Agents; D010404:Penicillin V