Antibiotics and vaccination in sickle cell disease
Prophylaxis with daily oral penicillin reduces the rate of pneumococcal infection and the mortality rate (1)
Prophylaxis should commence by the age of 3 months (when the level of foetal haemoglobin starts to reduce & the risk of splenic hypofunction increases) and should be continued throughout childhood.
Recommended doses of oral penicillin are (erythromycin may be used in patients with penicillin allergy):
- 62.5 mg daily up to age 1 year
- 125 mg daily up to age 3 year
- 250 mg daily thereafter
Pneumococcal vaccination should be given as soon as possible after diagnosis (1,2)
- a conjugated pneumococcal polysaccharide vaccine - this is immunogenic in the very young and is licensed for use in the under 6 month old
- 23-valent polysaccharide vaccine - only weakly immunogenic in children under 2 years old - should be used in older children
- usually at 2-3 years old, then every 5 years
All the other vaccines in the routine infant immunisation programme should be given:
- hepatitis B immunisation should also be offered to non immune children (2)
- children should also be immunised each autumn against influenza
Reference
- Rankine-Mullings AE, Owusu-Ofori S. Prophylactic antibiotics for preventing pneumococcal infection in children with sickle cell disease. Cochrane Database Syst Rev. 2021 Mar 8;(3):CD003427.
- Brousse V, Makani J, Rees DC; Management of sickle cell disease in the community. BMJ. 2014 Mar 10;348:g1765.
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