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Compliance with penicillin prophylaxis in patients with sickle cell disease
S J Teach1, K A Lillis, M Grossi
1Department of Pediatrics, State University of New York at Buffalo School of Medicine, USA. steach@cnmc.org
Insights
Measured compliance with penicillin prophylaxis in sickle cell disease patients was poor, with many families overreporting adherence. Younger children and those with private insurance showed better adherence, highlighting areas for improved interventions.
Area of Science:
- Pediatric Hematology
- Infectious Disease Prevention
- Pharmacological Adherence Research
Background:
- Penicillin prophylaxis is crucial for preventing infections in sickle cell disease (SCD).
- Adherence to prophylactic regimens is essential for effective disease management.
Purpose of the Study:
- To evaluate compliance with penicillin prophylaxis in pediatric patients with sickle cell hemoglobinopathies.
- To identify factors associated with adherence to penicillin therapy.
Main Methods:
- A prospective case series was conducted at an urban pediatric medical center.
- Compliance was assessed using structured interviews and urine assays for penicillin detection.
- Patients with sickle cell hemoglobinopathies were enrolled from emergency and sickle cell clinics.
Main Results:
- Measured compliance via urine assay was 43.1%, significantly lower than reported compliance (67.5%).
- Younger patients (<5 years) and those with private insurance demonstrated higher measured compliance.
- Discrepancies between reported and measured compliance suggest underreporting of nonadherence.
Conclusions:
- Measured compliance with penicillin prophylaxis in sickle cell disease patients is suboptimal.
- Patient and family reports of compliance are often inaccurate.
- Targeted interventions are needed to improve adherence, particularly in at-risk groups.
Objective:
To assess factors related to compliance with penicillin prophylaxis among patients with sickle cell disease.
Design:
Prospective case series.
Setting:
Urban pediatric medical center where universal penicillin prophylaxis is recommended for all patients with any sickle cell hemoglobinopathy independent of age.
Participants:
Eligible patients with sickle cell hemoglobinopathies were enrolled in either the emergency department or the sickle cell clinic.
Main Outcome Measures:
Compliance was assessed by structured interview and by urine assay with an established method (Micrococcus luteus with disk diffusion) that detects excreted penicillin up to 15 hours after each dose administration.
Results:
Of the 159 patients actively followed up at the sickle cell center, 123 (77.3%) eligible patients were enrolled. Reported compliance by structured interview (> or = 1 dose of penicillin V potassium within 15 hours of enrollment) was 83 of 123 patients (67.5%; 95% confidence interval, 59.2%-75.8%), whereas measured compliance as determined by urine assay was 53 of 123 patients (43.1%; 95% confidence interval, 31.3%-51.7%). Measured compliance was significantly greater in patients younger than 5 years than in those older than 5 years (25/41 [61%] vs 28/82 [34%], respectively; P = .004), and was significantly greater in patients with private insurance than in those with public insurance (17/28 [61%] vs 33/90 [37%], respectively; P = .02). Measured compliance was not significantly associated with sex, site of recruitment, hemoglobinopathy, or chief complaint in the emergency department.
Conclusions:
Measured compliance was poor, and patients and/or their families frequently misrepresented their compliance when interviewed. These data suggest that efforts are necessary to improve overall compliance, and they identify groups at greatest risk for noncompliance.