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Prophylactic antibiotics for preventing pneumococcal infection in children with sickle cell disease
Ceri Hirst1, Shirley Owusu-Ofori
1AstraZeneca, Alderley Park, UK. Ceri.Hirst@astrazeneca.com
Insights
Prophylactic penicillin significantly lowers the risk of pneumococcal infection in children with sickle cell disease. This antibiotic regimen is safe and effective, though optimal withdrawal age requires further study.
Area of Science:
- Pediatrics
- Infectious Diseases
- Hematology
Background:
- Children with sickle cell disease face heightened infection susceptibility, particularly from pneumococcus.
- Young children under three are especially vulnerable, with high rates of pneumococcal septicemia.
- Standard pneumococcal vaccines may offer limited protection in this age group.
Purpose of the Study:
- To evaluate the effectiveness of prophylactic antibiotics in preventing pneumococcal infections in children with sickle cell disease.
Main Methods:
- Systematic review of randomized and quasi-randomized controlled trials.
- Searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Haemoglobinopathies Trials Register.
- Data extraction and quality assessment performed independently by two authors.
Main Results:
- Three trials met inclusion criteria, all demonstrating reduced pneumococcal infection incidence with prophylactic penicillin.
- Initiating penicillin showed an odds ratio of 0.37 (95% CI 0.16 to 0.86) for infection.
- Adverse drug effects were infrequent and minor; infection rates were low in children over five.
Conclusions:
- Prophylactic penicillin is highly effective in reducing pneumococcal infection risk in children with homozygous sickle cell disease.
- The treatment is associated with minimal adverse effects.
- Further research is needed to establish the optimal age for discontinuing penicillin prophylaxis.
Background:
People with sickle cell disease are particularly susceptible to infection. Infants and very young children are especially vulnerable, and the 'Co-operative Study of Sickle Cell Disease' observed an incidence rate of 10 per 100 patient years of pneumococcal septicaemia in children under the age of three. Vaccines, including customary pneumococcal vaccines, may be of limited use in this age group. Therefore, prophylactic penicillin regimens may be advisable for this population.
Objectives:
To assess the effects of prophylactic antibiotic regimens for preventing pneumococcal infection in children with sickle cell disease.
Search Methods:
We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Haemoglobinopathies Trials Register, which is comprised of references identified from comprehensive electronic database searches and handsearches of relevant journals and abstract books of conference proceedings.Date of the most recent search: 28 March 2012.
Selection Criteria:
All randomised or quasi-randomised controlled trials comparing prophylactic antibiotics to prevent pneumococcal infection in children with sickle cell disease with placebo, no treatment or a comparator drug.
Data Collection And Analysis:
Both authors independently extracted data and assessed trial quality.
Main Results:
Five trials were identified by the initial search, of which three trials met the inclusion criteria. All of the included trials showed a reduced incidence of infection in children with sickle cell disease (SS or Sβ0Thal) receiving prophylactic penicillin. In trials which investigated initiation of penicillin on risk of pneumococcal infection, the odds ratio was 0.37 (95% CI 0.16 to 0.86), while for withdrawal the odds ratio was 0.49 (95% CI 0.09 to 2.71). Adverse drug effects were rare and minor. Rates of pneumococcal infection were found to be relatively low in children over the age of five.
Authors' Conclusions:
Prophylactic penicillin significantly reduces risk of pneumococcal infection in children with homozygous sickle cell disease, and is associated with minimal adverse reactions. Further research may help to determine the ideal age to safely withdraw penicillin.
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