Cochrane review: Prophylactic antibiotics for preventing pneumococcal infection in children with sickle cell disease

Abstract

AbstractBackgroundPeople with sickle cell disease are particularly susceptible to infection. Infants and very young children are especially vulnerable, and the 'Co‐operative Study of Sickle Cell Disease' observed an incidence rate of 10 per 100 patient years of pneumococcal septicaemia in children under the age of three. Vaccines, including customary pneumococcal vaccines, may be of limited use in this age group. Therefore, prophylactic penicillin regimens may be advisable for this population.ObjectivesTo assess the effects of prophylactic antibiotic regimens for preventing pneumococcal infection in children with sickle cell disease.Search strategyWe searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Haemoglobinopathies Trials Register, which is comprised of references identified from comprehensive electronic database searches and handsearches of relevant journals and abstract books of conference proceedings.Date of the most recent search: May 2006.Selection criteriaAll randomised or quasi‐randomised controlled trials comparing prophylactic antibiotics to prevent pneumococcal infection in children with sickle cell disease with placebo, no treatment or a comparator drug.Data collection and analysisBoth authors independently extracted data and assessed trial quality.Main resultsFive trials were identified by the initial search, of which three trials met the inclusion criteria. All of the included trials showed a reduced incidence of infection in children with sickle cell disease (SS or Sβ0Thal) receiving prophylactic penicillin. In trials which investigated initiation of penicillin on risk of pneumococcal infection, the odds ratio was 0.37 (95% CI 0.16 to 0.86), while for withdrawal the odds ratio was 0.49 (95% CI 0.09 to 2.71). Adverse drug effects were rare and minor. Rates of pneumococcal infection were found to be relatively low in children over the age of five.Authors' conclusionsProphylactic penicillin significantly reduces risk of pneumococcal infection in children with homozygous sickle cell disease, and is associated with minimal adverse reactions. Further research may help to determine the ideal age to safely withdraw penicillin.Plain language summaryRegular preventative antibiotics can reduce the risk of pneumococcal infection in young children with sickle cell diseasePeople with sickle cell disease are prone to infection, particularly respiratory infections and septicaemia (blood poisoning). Pneumococcal bacteria often cause these. Some vaccines are less effective in children younger than three years of age. Therefore, antibiotics can be given regularly to try and prevent infection in young children. The review found that penicillin reduced the rate of pneumococcal infection in children under the age of five with sickle cell disease, without major adverse effects. Older children were found to have a lower risk of infection, and therefore regular penicillin may not be as important in these children.