title: Compliance with antibiotic prophylaxis in children with sickle cell anemia: a prospective study.
abstract: OBJECTIVE
  To prospectively assess compliance with antibiotic prophylaxis among children with sickle cell anemia.
  
  
  METHODS
  A total of 108 children (aged 3 months to 4(1/2) years, 45% male) were recruited from the Hematology Center in Belo Horizonte, Brazil, and followed up for 15 months. Data on compliance were obtained from three interviews with the primary caregivers, from the children's medical records and from assay of antibacterial activity in urine samples of 81 children. Antibiotics were available free of charge.
  
  
  RESULTS
  Penicillin was used in 106 cases (majority by oral route); erythromycin in 2 cases. Urine samples tested positive for the antibiotic in 56% of the cases; 48% of the caregivers assured during interviews that all doses had been administered to children; 89% of medical files recorded no compliance failures. Considering a child compliant if none or just one of these methods detected missing doses, the rate of compliance was 67%. The agreement between methods for assigning a child as compliant or not was low. No significant association of compliance rate with gender, nutritional status, per capita income of the family, caregivers' schooling, or number of family members was demonstrated.
  
  
  CONCLUSIONS
  Compliance rate with prophylactic antibiotic therapy was low when assessed by interviews and urine tests and overestimated by analysis of medical records. Compliance should preferably be assessed by several methods due to the complex character of its measurement. The results of the present study suggest the need for a comprehensive educational program involving healthcare professionals, families and children with sickle cell anemia.
authors.affiliation: Fundação Mineira de Educação e Cultura - Faculdade de Ciências da Saúde (FUMEC-FCS), Belo Horizonte, MG, Brazil.
authors.forename: Enio Latini
authors.initials: EL
authors.lastname: Bitarães
authors.forename: Benigna Maria de
authors.initials: BM
authors.lastname: Oliveira
authors.forename: Marcos Borato
authors.initials: MB
authors.lastname: Viana
mesh_terms: D000755:Anemia, Sickle Cell / Q000150:complications*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis; D001938:Brazil; D017028:Caregivers; D002675:Child, Preschool; D004334:Drug Administration Schedule; D004917:Erythromycin / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007223:Infant; D007407:Interviews as Topic; D008297:Male; D009752:Nutritional Status; D010353:Patient Education as Topic; D010401:Penicillin G Benzathine / Q000627:therapeutic use; D010404:Penicillin V / Q000008:administration & dosage / Q000627:therapeutic use; D010406:Penicillins / Q000627:therapeutic use*; D011446:Prospective Studies; D016903:Drug Monitoring
chemical_list: D000900:Anti-Bacterial Agents; D010406:Penicillins; D004917:Erythromycin; D010401:Penicillin G Benzathine; D010404:Penicillin V