title: Prophylactic penicillin after 5 years of age in patients with sickle cell disease: a survey of sickle cell disease experts.
abstract: BACKGROUND
  Since the publication of the Prophlyactic Penicillin Study II in 1995, the management of penicillin prophylaxis for children with sickle cell disease (SCD) after 5 years of age has been controversial. In this study, we sought to describe current practice patterns of pediatric hematologists related to cessation of penicillin prophylaxis for children with SCD after 5 years of age.
  
  
  METHODS
  We performed a cross-sectional, electronic survey of pediatric hematologists with expertise in SCD to examine practices regarding penicillin prophylaxis in children with SCD after 5 years of age. We also investigated factors potentially associated with continuation of penicillin prophylaxis using the Jonckheere-Terpstra test and Fisher's exact test.
  
  
  RESULTS
  Of the 106 physicians surveyed from 76 centers, 84% completed the survey. Among respondents, 76% routinely recommended cessation of penicillin prophylaxis after 5 years of age. The practice of routinely continuing penicillin after 5 years of age was associated with decreased concern about antibiotic resistance in Streptococcus pneumoniae (P = 0.01), with the usage of prophylactic penicillin in mild SCD genotypes (sickle hemoglobin-C disease and sickle β(+) thalassemia, P = <0.001), and with increasing use of other preventive evaluations (e.g., MRI for silent stroke) in childhood (P = 0.05).
  
  
  CONCLUSIONS
  Most pediatric hematologists with an SCD expertise recommend cessation of prophylactic penicillin after 5 years of age.
authors.affiliation: Division of Hematology-Oncology, University of Texas Southwestern Medical Center, Dallas, TX 75390-9063, USA. tim.mccavit@childrens.com
authors.forename: Timothy L
authors.initials: TL
authors.lastname: McCavit
authors.forename: Megan
authors.initials: M
authors.lastname: Gilbert
authors.forename: George R
authors.initials: GR
authors.lastname: Buchanan
mesh_terms: D000755:Anemia, Sickle Cell / Q000150:complications*; D019072:Antibiotic Prophylaxis / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D006801:Humans; D010406:Penicillins / Q000627:therapeutic use*; D010820:Physicians; D011008:Pneumococcal Infections / Q000150:complications / Q000517:prevention & control*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*
chemical_list: D010406:Penicillins