Pneumococcal septicemia despite pneumococcal vaccine and prescription of penicillin prophylaxis in children with sickle cell anemia
G. R. Buchanan and S. J. Smith
Although polyvalent pneumococcal vaccine and prophylactic penicillin are
used to prevent overwhelming Streptococcus pneumoniae septicemia in infants
and young children with sickle cell anemia, infection rates remain high. We
have reviewed our seven-year experience with a regimen of twice daily oral
penicillin V potassium prophylaxis in 88 affected children. The median age
at the start of prophylaxis was 10 months, and the median duration of
prophylaxis was 29 months (range, three months to seven years). The total
period of observation of patients who were prescribed penicillin was 248
person-years. Most patients also received one or two doses of polyvalent
pneumococcal vaccine. Despite penicillin prophylaxis and pneumococcal
vaccine, eight episodes of S pneumoniae septicemia have occurred and three
have been fatal. Four episodes were in children older than 3 years.
Suboptimal compliance with the prescribed oral penicillin regimen was
usually apparent. With one possible exception, the infections occurred when
penicillin had not been taken during the previous 24 hours. The S
pneumoniae septicemia rate in this patient population, 3.2 per 100
person-years, is somewhat less than that described in previous reports of
children not receiving penicillin but is still unacceptably high. Vigorous
advocacy of a penicillin prophylaxis regimen does not eliminate the risk of
pneumococcal septicema in this patient population.
