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Trying to improve compliance with prophylactic penicillin therapy in children with sickle cell disease
M Berkovitch1, D Papadouris, D Shaw
1Division of Pediatrics, Assaf Harofeh Medical Center, Sackler School of Medicine, Tel-Aviv University, Israel.
Insights
Compliance with prophylactic penicillin in children with sickle cell disease (SCD) is highly variable. An intervention did not significantly improve adherence, indicating challenges in monitoring and treatment effectiveness for SCD management.
Area of Science:
- Pediatrics
- Hematology
- Pharmacology
Background:
- Sickle cell disease (SCD) is a genetic blood disorder requiring lifelong management.
- Prophylactic penicillin therapy is crucial for preventing infections in children with SCD.
- Adherence to prophylactic penicillin is essential for reducing morbidity and mortality in pediatric SCD patients.
Purpose of the Study:
- To evaluate compliance with prophylactic penicillin therapy in children diagnosed with sickle cell disease (SCD).
- To assess the effectiveness of a multi-component intervention aimed at improving penicillin adherence in pediatric SCD patients.
Main Methods:
- A randomized controlled trial involving 45 children with homozygous SCD.
- Intervention group received educational materials, weekly social worker calls, and a calendar.
- Compliance monitored using the Medication Event Monitoring System over a 6-month period.
Main Results:
- Baseline compliance was approximately 66-69% in both groups.
- No statistically significant difference in compliance was observed between the intervention and non-intervention groups post-intervention (79% vs 66%) or during monitoring (82% vs 66%).
- Compliance rates demonstrated high variability within both groups throughout the study.
Conclusions:
- Compliance with prophylactic antibiotic therapy in children with SCD is highly variable.
- Current methods for evaluating compliance in pediatric SCD patients present challenges.
- Further research is needed to develop effective strategies for improving adherence to prophylactic penicillin in children with SCD.
Aims:
To evaluate compliance with prophylactic penicillin therapy in sickle cell disease (SCD) in children.
Methods:
Forty-five children aged 37 +/- 19 (9-84) months [mean +/- s.d; range] with homozygous SCD were recruited. After a baseline period of 2 months the patients were randomized to either the intervention or non-intervention group. The intervention consisted of a slide show explaining the pathogenesis of sickle cell disease and its complications; weekly phone calls by the clinic social worker; and a calendar. Compliance was again evaluated after the 2 month intervention period and after a further 2 month monitoring period without intervention. Compliance was monitored using the Medication Event Monitoring System. At the end of the 6 months, parents in both groups completed a questionnaire the aims of which were to determine knowledge and understanding of sickle cell disease and previous experience with infection. Patient admissions to the hospital during the study were recorded.
Results:
Compliance during the 2 month baseline assessment was 66.0 +/- 32.5 (1.3-98.2)% and 69.3+25.4 (19.8-96.5)% in the intervention (n = 13) and non-intervention (n = 10) groups respectively (P = 0.79). During the next 2 months, compliance in the intervention group (n = 11) was 79.0 +/- 31.4 (11.0-100.0)% and in the non-intervention group (n = 9) was 66.0 +/- 20.2 (42.2-96.8)% (P = 0.297). In the final 2 month monitoring period compliance was 82.0 +/- 34.7 (3.8-100.0)% and 65.8 +/- 25.3 (25.0-98.2)% in the intervention (n = 7) and the non-intervention (n = 6) groups respectively (P = 0.366). No statistically significant differences were found when comparing compliance between the groups.
Conclusions:
Compliance with prophylactic antibiotic therapy in children with sickle cell disease is highly variable and its evaluation is problematic.