The Use of Penicillin for the Prevention of Pneumococcal Infection in Pediatric Patients with Sickle Cell Disease

Abstract

Background: Children with sickle cell disease and asplenia are at a 30-600-fold increased risk of acquiring  Streptococcus pneumoniae infection when compared to children without this disease. Prevention of such infection is vital in this population. Data sources: We searched PubMed with the key words penicillin, pediatric, pneumococcal vaccines, and sickle cell anemia and selected publications that were deemed appropriate. Results: Penicillin prophylaxis has been shown to be efficacious in children less than 5 years of age, but its therapeutic benefits in children over the age of 5 remain unknown.  One Cochrane review and three randomized trials evaluated the efficacy of penicillin prophylaxis across different age groups in patients with HbSS and Sβ0Thal sickle cell disease. The rate of pneumococcal infection in the three trials combined showed a reduction (OR 0.37, 95%CI 0.16-0.86) of Streptococcus pneumoniae infection in children less than 5 years old who had received penicillin prophylaxis.  The risk of such infection was lower in children over the age of 5.  Long-term prophylaxis of SCD patients with penicillin poses a concern of drug-resistant strain of the S. pneumoniae and this risk continues to be a significant area of controversy. Conclusions: Infection caused by Streptococcus pneumoniae is reduced with the use of penicillin prophylaxis under the age of 5. It may be safe to discontinue prophylaxis in patients without splenectomy and history of severe pneumococcal sepsis once the patient has reached 5 years old due to unclear benefit and the potential risk of developing penicillin induced-streptococcal resistance.