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Penicillin prophylaxis in children with sickle cell disease in Brent
D Cummins1, R Heuschkel, S C Davies
1Department of Haematology, Central Middlesex Hospital, London.
Insights
Many children with sickle cell disease do not receive adequate oral penicillin prophylaxis due to poor compliance. Improved education for families and healthcare providers is crucial for preventing serious infections like pneumococcal sepsis.
Area of Science:
- Pediatric Hematology
- Infectious Disease Prevention
- Public Health
Background:
- Sickle cell disease (SCD) necessitates lifelong oral penicillin prophylaxis to prevent severe infections.
- Compliance with penicillin prophylaxis in children with SCD is a significant clinical challenge.
- Lack of awareness regarding the critical role of penicillin in preventing pneumococcal sepsis contributes to poor adherence.
Purpose of the Study:
- To evaluate the adherence to oral penicillin prophylaxis in pediatric SCD patients.
- To identify underlying factors contributing to suboptimal compliance.
- To assess the awareness of healthcare providers regarding the importance of penicillin prophylaxis in SCD.
Main Methods:
- A cross-sectional study involving questionnaires administered to parents of children with SCD and general practitioners.
- Urine samples were analyzed to objectively verify penicillin intake.
- Study conducted in a pediatric hematology clinic and local general practices.
Main Results:
- A significant discrepancy was observed between reported penicillin intake and confirmed presence in urine samples.
- Many parents and healthcare providers demonstrated a lack of understanding regarding the life-saving importance of regular penicillin prophylaxis.
- Low awareness of the link between penicillin prophylaxis and the prevention of pneumococcal sepsis and mortality was noted.
Conclusions:
- Enhanced educational initiatives are imperative for families managing children with SCD.
- Targeted information and specialized training for healthcare professionals in high-SCD prevalence areas are essential.
- Improving understanding of penicillin prophylaxis benefits can significantly improve child health outcomes in SCD.
Objective:
To assess compliance with oral penicillin prophylaxis in children with sickle cell disease and identify possible reasons for poor compliance.
Design:
Closed questionnaires given to parents of children with sickle cell disease and general practitioners in Brent. Urine samples from 23 children were tested for penicillin.
Setting:
Paediatric haematology clinic, Central Middlesex Hospital, and general practices in Brent.
Subjects:
50 children (aged less than or equal to 16) attending clinic with sickle cell disease over six months (33 HbSS, 12 HbSC, five HbS beta thalassaemia). 30 general practitioners: 15 with the greatest number of patients with sickle cell disease on the Brent register; 15 selected randomly from family practitioner committee's list.
Main Outcome Measures:
Reported compliance with and awareness of importance of penicillin prophylaxis. Results of urine tests for penicillin.
Results:
31 parents claimed that their children received penicillin every day and 19 that they received it most days (greater than or equal to 5 days a week). Penicillin was detected in only 10 of 23 urine samples tested. Parents and doctors seemed not to appreciate the importance of treatment: only eight parents were aware of the risk of death if penicillin were discontinued, and 16 doctors were unaware that regular penicillin prophylaxis prevents pneumococcal septicaemia and death in these children.
Conclusions:
Education for families with children with sickle cell disease must be improved. Specialised information and training are needed for doctors working in areas with a high prevalence of the disorder.