Compliance with intramuscular penicillin prophylaxis in children with sickle cell disease in Jamaica

Penicillin prophylaxis is important in the defence against invasive pneumococcal disease in sickle cell disease (SCD). Penicillin may be administered by the oral route or by the intramuscular (IM) route. Compliance with the oral route, although difficult to assess, has been reported to be highly variable and often poor. We sought to determine the compliance rate with intramuscular penicillin (IM) prophylaxis in children with sickle cell disease.

Children followed at the Sickle Cell Unit in Jamaica were recruited. Good compliance was deemed if patients received at least 10 injections over the preceding 12-months. Children on IM prophylaxis for less than a 12-month period were deemed to be compliant if they received 80% of injections since commencing prophylaxis.

Data were available for 78 (HB SS 73; male 42) patients attending the clinic during the period of observation. Sixty-nine (88.5%) of the children were compliant with IMpenicillin prophylaxis.

This study reports a high compliance (88.5%) to IM penicillin prophylaxis which was associated with an incidence rate of invasive pneumococcal disease lower than what is seen in other comparable studies, reflecting the route of administration. Intramuscular penicillin prophylaxis, despite challenges, is a practical option. It can contribute to better patient compliance and thus significantly impact global rates of invasive pneumococcal disease and its complications in children with SCD and other similar conditions.