 |
|
Compliance With Penicillin Prophylaxis in Patients With Sickle Cell Disease
Stephen J. Teach, MD, MPH;
Kathleen A. Lillis, MD;
Mauro Grossi, MD
Arch Pediatr Adolesc Med. 1998;152:274-278.
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 ( 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.
From the Department of Pediatrics, State University of New York at Buffalo School of Medicine and Biomedical Sciences and the Children's Hospital of Buffalo. Dr Teach is now with the Children's National Medical Center, George Washington University School of Medicine, Washington, DC.
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
Standards for the management of sickle cell disease in children
Dick
EDUCATION AND PRACTICE 2008;93:169-176.
ABSTRACT
| FULL TEXT
Effectiveness of the 7-Valent Pneumococcal Conjugate Vaccine in Children With Sickle Cell Disease in the First Decade of Life
Adamkiewicz et al.
Pediatrics 2008;121:562-569.
ABSTRACT
| FULL TEXT
Research for Newborn Screening: Developing a National Framework
Botkin
Pediatrics 2005;116:862-871.
ABSTRACT
| FULL TEXT
Provision of Pneumococcal Prophylaxis for Publicly Insured Children With Sickle Cell Disease
Sox et al.
JAMA 2003;290:1057-1061.
ABSTRACT
| FULL TEXT
The Complex Relationship of Genetics, Groups, and Health: What It Means for Public Health
Clayton
J Law Med Ethics 2002;30:290-297.
|
