Variability in the Management of Antibiotic Prophylaxis for Patients with Asplenia

To assess the variation in the duration of antibiotic prophylaxis prescribed for patients with asplenia among US pediatric subspecialists.

A survey was e-mailed to pediatric infectious diseases, hematology/oncology, cardiology, and surgery providers at US academic medical centers. Questions addressed prescribing practices in patients with asplenia/hyposplenia.

There were 58 respondents who managed antibiotic prophylaxis in patients with asplenia/hyposplenia. Thirty-nine managed patients with nonsurgical disorders of the spleen; most prescribed prophylaxis until 5 years of age for patients with sickle cell disease, but duration varied for congenital anatomic asplenia, situs inversus, polysplenia, and hereditary spherocytosis. Thirty-three managed patients who had undergone surgical splenectomy due to a medical condition. Thirty-five managed patients who had undergone surgical splenectomy due to trauma. Duration of prophylaxis was longer for patients who were younger at the time of splenectomy. Respondents were more likely to prescribe prophylaxis for patients who underwent surgical splenectomy for a medical reason compared with trauma. Thirty-seven institutions were represented; 17 had ≥2 respondents. There was practice variation among individuals from the same institution. Ninety-three percent of all respondents reported their clinical practice would benefit from consensus guidance.

There is wide practice variation in the duration of antibiotic prophylaxis prescribed for patients with asplenia or hyposplenia. These varying practice patterns illustrate the need for outcomes research and expert consensus guidance.