Antibiotic Prophylaxis for Children with Sickle Cell Anemia is Important: Then Why Aren’t We Routinely Doing It? :

It is well known that antibiotic prophylaxis reduces the risk of invasive pneumococcal disease in children with sickle cell anemia (SCA). Yet how good are families at complying with antibiotic prophylaxis for their child with this hemoglobinopathy? Reeves et al. (10.1542/peds.2017-2182) used Medicaid claims data from 2005-2012 to look at children with SCA from ages 3 months to 5 years in 6 states and whether prescriptions for antibiotics were filled to cover more than 300 days a year of prophylaxis.  Various demographic risk factors were then identified that were associated with increased odds of getting year-round prophylaxis.  The results report on more than 2800 children and, sadly, only 18% of those studied got ≥ 300 days of penicillin, erythromycin, or amoxicillin in a given year.  The good news is that the more likely a child with SCA was to have an outpatient visit either for their disease or for health maintenance, the more likely they were to receive their prophylaxis routinely.  The authors do a nice job discussing what might be contributing to lack of compliance and what we can do to enhance that compliance.  You’ll find this study is anything but complicated when it comes to thinking about what we can do to enhance antibiotic prophylaxis compliance in our patients with sickle cell disease to reduce serious infectious complications.