Pneumococcal Infections In Children Research Articles

Prophylactic antibiotics for preventing pneumococcal infection in children with sickle cell disease.

Background This is an update of a Cochrane Review first published in 2002, and previously updated in 2012. People 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.Objectives To assess the effects of prophylactic antibiotic regimens for preventing pneumococcal infection in children with sickle cell disease.Search methods We 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: 26 June 2014.Selection criteria All 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 analysis Both authors independently extracted data and assessed trial quality.Main results Five 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' conclusions Prophylactic 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.

What you need to know about pneumococcal vaccination

Q: What do I need to know about pneumococcal vaccines?FigureA: The first pneumococcal vaccine—PCV7—was licensed in 1977. The vaccines currently in use for children and adults to protect against pneumococcal infections are pneumococcal conjugate vaccine 13 (PCV13) and pneumococcal polysaccharide vaccine 23 (PPSV23). PCV13 provides children younger than age 2 with immunity against 80% of the most common strains of pneumococcal disease. The 2014 PPSV23 protects patients age 2 and older against 23 different types of pneumococcal bacteria, including serotype 19a, which is responsible for approximately 46% of all pneumococcal infections in children and adults. Of the 46% of patients who have the serotype 19a strain, 30% have multidrug-resistant pneumococcal infections. Most patients develop immunity within 2 to 3 weeks after they're vaccinated with PCV13 or PPSV23. The CDC recommends that PCV13 be administered in four doses to infants at the following ages: first dose at 2 months second dose at 4 months third dose at 6 months fourth dose at 12 to 15 months. PCV13 should also be administered to all children younger than age 5 and adults with certain risk factors, such as cochlear implants, cerebrospinal fluid (CSF) leaks, sickle cell disease, asplenia, and immunocompromised patients. All adults older than age 65, those over age 19 at high risk for acquiring pneumococcal disease, and children age 2 or older who are at high risk should also receive PPSV23. Patients who should receive PPSV23 each year include: all adults older than age 65 adults ages 19 to 64 who smoke or have asthma patients ages 2 to 54 who have lung disease, cirrhosis, heart disease, diabetes, alcoholism, sickle cell anemia, CSF leakage, cochlear implants, renal failure, Hodgkin disease, leukemia, lymphoma, recent joint replacements, multiple myeloma, and HIV/AIDS organ transplant recipients patients taking chemotherapy or steroid medications oncology patients receiving radiation therapy. Children should be evaluated on a case-by-case basis by the healthcare team. Factors that may be considered include the child's current clinical health and any chronic or immunosuppressive diseases he or she may have to decide if the potential risk warrants vaccination. If a patient received his or her initial vaccination before age 65, he or she should receive an additional PPSV23 vaccination yearly after turning age 65 to maintain the same immunity. Additionally, patients ages 2 to 64 who have any of the following conditions should be individually considered for yearly PPSV23: damaged spleen or splenectomy sickle cell disease HIV/AIDS cancer, leukemia, lymphoma, or multiple myeloma nephrotic syndrome organ or bone marrow transplant chemotherapy or steroids that are known to lower the body's immunity. Since the initial recommendation, invasive pneumococcal disease in children has dropped by nearly 80% in the United States over the last 3 decades. PCV13 has very few adverse reactions. According to the CDC, in approximately 60,000 doses of PCV13 administered, there have been no reported moderate or severe reactions. However, approximately 20% of patients who receive PCV13 will experience mild adverse reactions, such as injection site reactions (localized pain, tenderness, and edema at the injection site), fever, decreased appetite, irritability, and increased or decreased sleep. Adverse reactions to PPSV23 are usually mild, such as localized pain or erythema at the injection site that typically resolves within 48 hours. According to the National Institutes of Health, less than 1% of the population will experience a mild fever. Observe for signs and symptoms of an allergic reaction, such as dyspnea, increased work of breathing, hoarseness or wheezing, hives, paleness, weakness, increased heart rate, and dizziness. If these symptoms occur, have a team member stay with the patient and consult with the physician immediately; monitor the patient's respiratory rate for the potential need for rescue breathing. Provide information both verbally and in print to your patients on the benefits and risks associated with vaccination so that the patient, caregiver, or legal guardian can make a well-informed decision.

PSY30 - Penicillin and amoxicillin prophylaxis in children with sickle cell disease (SCD): compliance and cost comparison

To discuss the amoxicillin use as an alternative to penicillin and compare its cost for antibiotic prophylaxis in children with SCD. We searched for evidences in MEDLINE (Pubmed) with the terms "Anemia, Sickle Cell"[Mesh] and "Antibiotic Prophylaxis"[Mesh]. In a deterministic fashion, adopting the Brazilian public health system perspective, we did a budget impact analysis comparing amoxicillin to penicillin. The target population was estimated from hidroxyurea consumption in children with SCD and acquisition costs, both obtained from Ministry of Health databases (2012 values; exchange rate: US$ 1 = R$ 2.04). Data about dosage according to age and bodyweight were extracted from literature. A systematic review supports the use of penicillin prophylaxis in children with SCD, based on 3 RCTs (OR: 0.37; CI 95%: 0.16 to 0.86), with no results for amoxicillin. Although, prospective studies show a low compliance of this approach (40 to 60%). Comparisons of amoxicillin to penicillin in other settings, as rheumatic fever prevention, demonstrate that once-daily oral amoxicillin is not inferior to twice-daily penicillin. We estimated a range of 143 to 325 children, less than 5 years old, with SCD as our target population. Assuming oral daily doses of 1500 mg (or 750 mg if bodyweight less than 30 kg) for amoxicillin and 500 mg (or 250 mg if bodyweight less than 20 kg) for penicillin, the annual acquisition costs of penicillin, oral solution, to treat this population can lead to expenses of US$ 41,161.93 to US$ 93,704.65. In contrast, expenses with amoxicillin, oral solution, would be a range of US$ 3,019.94 to US$ 6,863.49. As well as penicillin, amoxicillin seems to be a good option for preventing pneumococcal infection in children with SCD as its use could represent annual savings of US$ 38,141.99 to US$ 86,841.15 and the once-daily administration could improve the prophylaxis compliance.

Carriage rate and serotypes of Streptococcus pneumoniae amongst children in Thika Hospital, Kenya.

Streptococcus pneumoniae is a major cause of morbidity and mortality worldwide. Rates of carriage are highest in infants and the elderly. The objectives of this study were to determine the rate of nasopharyngeal colonization by S. pneumoniae, and to describe the antibiotic resistant patterns and the serotypes of the carried isolates. A cross-sectional study design was used. Nasopharyngeal swabs were collected from 315 children in the months of October and November 2010 and processed to isolate S. pneumoniae. The isolates were serotyped by the Quellung reaction and their antibiotic susceptibilities assessed by the disc diffusion method. The overall nasopharyngeal carriage rate for S. pneumoniae was 17%. Seventeen serotypes were detected amongst 55 strains analysed: 6A, 23F, 19F, 13, 6B, 14A, 20, 7C, 1, 15B, 35B, 19A, 11A, 34, 5, 3 and 23A. Susceptibility testing revealed that nearly all (98%) were resistant to cotrimoxazole, 9% were resistant to penicillin and 7% to cefotaxime. Resistance to chloramphenicol and erythromycin was 2% and 4%, respectively. All isolates were fully sensitive to tetracycline.High levels of cotrimoxazole resistance and some resistance to other antimicrobial agents commonly used in Thika District Hospital shows that there is need to revise antimicrobial policy in this region in the treatment of invasive pneumococcal infections. The frequent serotypes found in this study have previously been associated with pneumococcal infections in children. Several of these serotypes are included in the ten-valent vaccine and therefore use of this vaccine will help reduce pneumococcal infections in Thika.

Early Trends for Invasive Pneumococcal Infections in Children After the Introduction of the 13-valent Pneumococcal Conjugate Vaccine

The 13-valent pneumococcal conjugate vaccine (PCV13) was introduced for routine administration to infants and children in 2010 in the United States. We have monitored clinical and microbiologic features of invasive pneumococcal infections among children before and after PCV13 use. Infants and children cared for at 8 children hospitals in the United States with culture-proven invasive infections caused by S. pneumoniae were identified in an ongoing prospective surveillance study. Demographic and clinical data were recorded on a standard case report form. Serotype and antimicrobial susceptibilities of isolates were determined. Since routine PCV13 immunization in 2010, invasive pneumococcal infections decreased 42% overall and 53% for children <24 months of age in 2011 compared with the average number of cases for 2007 to 2009. PCV13 serotype isolates decreased 57% during these same time periods; 19A, 7F and 3 decreased by 58%, 54% and 68%, respectively. The number of infections caused by serotypes 1 and 6C also decreased in 2011. The most common non-PCV13 serotypes encountered in 2010 and 2011 combined were 33F, 22F, 12, 15B, 15C, 23A and 11. Bacteremia, pneumonia and mastoiditis cases decreased more than meningitis cases. After the introduction of PCV13, invasive pneumococcal infections decreased among 8 children hospitals compared with the 3 years before PCV13 use. Slight increases in some non-PCV13 serotype isolates were noted in 2011. Continued surveillance is necessary to determine the effectiveness of PCV13 including herd protection as well as any emerging invasive serotypes.

Pneumococcal infection in children of early age from risk groups: preventive maintenance possibilities

The Article is devoted to an actual problem of modern public Healthcare — Pneumococcal infections and possibilities of their prophylaxis. Background. To develope the effective and safe specific prevention method of pneumococcal disease in children of risk groups with the use of conjugated and polysaccharide-based vaccines. Materials and methods. 285 children of both genders aged from 6 months to 5 years old with various deviations in health status and risk factors of development of invasive pneumococcal disease were included in the study. Children from the main group (n=218) were immunized by the seven-valent pneumococcal conjugate vaccine (PCV7), part of children (n=31) were primary vaccinated by PCV7 later and received a boost dose of polysaccharide vaccine (PPV-23), children in the control group (n=36) were once immunized by PPV-23. Safety, clinical and immunological effectiveness of various schemes of vaccination were evaluated. Results. Frequency of adverse events to the introduction of PCV7 such as fever were up to 6.4%, local reactions — 4,6%. The majority of children (87—89%), immunized with PCV7 had elevated level of specific antibodies in more than 3 times compairing to the control group. In children vaccinated with PCV7, the number of pneumonia cases decreased to 6.8 times, acute average otitis — to 3,5 times, ARD — to 1,3 times.

Reprint of: Serotyping and antibiotic susceptibility of Streptococcus pneumoniae strains isolated in Algeria from 2001 to 2010

IntroductionPneumococcal infections are a major public health problem because of the virulence of this bacterium and its ability to develop resistance. Material and methodTwo hundred and ninety-four strains of Streptococcus pneumoniae were isolated from sterile (56.8%) and non-sterile samples (43.2%), from January 2001 to July 2010. ResultsThe interpretation of antibiotic susceptibility testing, according to CLSI criteria (M100-S21 2011), yielded a 25.2% overall resistance to penicillin, with 23.5% of strains isolated from CSF (meningitis), and only 1.7% in other samples. Resistance to cefotaxime was 8.1% (including 4.4% at a high level). The most common serotypes were: 14 (19.5%), 23F (9.7%), 6B (9.3%), 19F (5.4%), and serotype 1 (5%). The percentage of these serotypes isolated from normally sterile sites in children under 5 years of age was 31.25% for 14, 10.4% for 23F, 8.3% for 19F, 6.25% for 6B, and 4.2% for serotype 1. The theoretical vaccinal coverage against invasive infections in children under 2 years of age was 61.5%, 69.2%, and 76.9% for the 7-valent, 10-valent, and 13-valent conjugate vaccines, respectively. Penicillin non-susceptible Streptococcus pneumoniae (PNSP) strains accounted for 67.1, 68.6, and 72.8% for each of these three vaccines. ConclusionThere was a variation of serotype rates compared to previous studies. The increase in pneumococcal antibiotic resistance is concerning, particularly for the treatment of pneumococcal infections in children and infants. Pneumococcal vaccination is not compulsory yet in Algeria.

Comparison of the Severity and Outcome of Invasive Pneumococcal Infections in Children and Adults

In a population-based observational study of 285 patients with positive blood culture for pneumococci, we found that the course and outcome of invasive pneumococcal infections differ considerably between adults and children. None of the children died, whereas the infection was fatal for 15% (35/229) of the adults (P<0.001). The differences are only partly explained by the underlying conditions.

Pediatric Invasive Pneumococcal Disease in the United States in the Era of Pneumococcal Conjugate Vaccines

Invasive infections caused by Streptococcus pneumoniae continue to be a major cause of morbidity and mortality worldwide, especially in children under 5 years of age. In the United States, 90% of invasive pneumococcal infections in children are caused by 13 serotypes of S. pneumoniae. The licensure (in 2000) and subsequent widespread use of a heptavalent pneumococcal conjugate vaccine (PCV7) have had a significant impact on decreasing the incidence of serious invasive pneumococcal disease (IPD) in all age groups, especially in children under 2 years of age. However, the emergence of replacement non-PCV7 serotypes, especially serotype 19A, has resulted in an increase in the incidence of serious and invasive infections. In 2010, a 13-valent PCV was licensed in the United States. However, the impact that this vaccine will have on IPD remains to be seen. The objectives of this review are to discuss the epidemiology of serious and invasive pneumococcal infections in the United States in the PCV era and to review some of the pneumococcal vaccines that are in development.

ANALYSIS OF PNEUMOCOCCAL VACCINATION EFFICACY AND SAFETY IN CHILDREN WITH VARIOUS DISABILITIES OF HEALTH

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Serotyping and antibiotic susceptibility of Streptococcus pneumoniae strains isolated in Algeria from 2001 to 2010

IntroductionPneumococcal infections are a major public health problem because of the virulence of this bacterium and its ability to develop resistance. Material and methodTwo hundred and ninety-four strains of Streptococcus pneumoniae were isolated from sterile (56.8%) and non-sterile samples (43.2%), from January 2001 to July 2010. ResultsThe interpretation of antibiotic susceptibility testing, according to CLSI criteria (M100-S21 2011), yielded a 25.2% overall resistance to penicillin, with 23.5% of strains isolated from CSF (meningitis), and only 1.7% in other samples. Resistance to cefotaxime was 8.1% (including 4.4% at a high level). The most common serotypes were: 14 (19.5%), 23F (9.7%), 6B (9.3%), 19F (5.4%), and serotype 1 (5%). The percentage of these serotypes isolated from normally sterile sites in children under 5 years of age was 31.25% for 14, 10.4% for 23F, 8.3% for 19F, 6.25% for 6B, and 4.2% for serotype 1. The theoretical vaccinal coverage against invasive infections in children under 2 years of age was 61.5%, 69.2%, and 76.9% for the 7-valent, 10-valent, and 13-valent conjugate vaccines, respectively. Penicillin non-susceptible Streptococcus pneumoniae (PNSP) strains accounted for 67.1, 68.6, and 72.8% for each of these three vaccines. ConclusionThere was a variation of serotype rates compared to previous studies. The increase in pneumococcal antibiotic resistance is concerning, particularly for the treatment of pneumococcal infections in children and infants. Pneumococcal vaccination is not compulsory yet in Algeria.

Invasive Pneumococcal Infection in Children Aged Less than Five Years: A Report from Tertiary Care Hospital from Western India

Background<italic>Streptococcus pneumoniae</italic> is the leading cause of morbidity and mortality worldwide especially among children less than 5 years of age.To detect the prevalence of invasive <italic>Streptococcus pneumoniae</italic> in children aged less than 5 years and to determine the antimicrobial susceptibility profile with special reference to penicillin resistance in a tertiary care hospital.MethodsClinical specimens like pus, blood, cerebrospinal fluid and other sterile body fluids obtained from infected children were processed for isolation and identification of <italic>Streptococcus pneumoniae.</italic> Kirby Bauer disc diffusion test was performed to determine the antimicrobial susceptibility profile. Minimum inhibitory concentration was determined for penicillin in those isolates showing resistance to this antibiotic on disc diffusion test.ResultsPrevalence of invasive pneumococcal infection was found to be 33.4% in children aged less than 5 years. Penicillin resistance was encountered in 3.4% cases of invasive isolates. These isolates exhibited 25.4% &amp; 10.1% resistance to co-trimoxazole and chloramphenicol respectively.Invasive pneumococcal infections in children may have a poor prognosis and penicillin-resistant strains have become increasingly common. This study emphasises the importance of judicious use of antibiotics, especially to refrain their use in mild self-limiting upper respiratory infections.

Antibiotic Resistance in Streptococcus pneumonia: A Disaster in the making

Sir William Osler once called S. pneumoniae Captain of the men of death. Streptococcus pneumonia, the most common cause of community acquired pneumoniae, otitis media and meningitis is the sixth leading cause of death in the world. Children under the age of 5, elderly individuals and individuals with co-morbidities such as cardiovascular disease, diabetes, and immuncompromised individuals are at the highest risk of acquiring pneumococcal infections. The World Health Organization (WHO) estimates between 11 and 18 million cases of pneumococcal infection in children under the age of 5 and approximately 826,000 deaths globally. Pneumococcal infections account for approximately 11% of all deaths that occur in children under the age of 5 yrs. S. pneumoniae is also the most frequent cause of community acquired pneumonia (CAP) accounting for 20-60% cases of CAP and 11-20% of CAP associated mortality.

Serotype 19A Is the Most Common Serotype Causing Invasive Pneumococcal Infections in Children

The purpose of this study was to monitor the clinical and microbiologic features of invasive infections caused by Streptococcus pneumoniae among children before and after the introduction of the 7-valent pneumococcal conjugate vaccine (PCV7). We conducted a 15-year prospective surveillance study of all invasive pneumococcal infections in children. The sample included infants and children at 8 children's hospitals in the United States with culture-proven invasive S pneumoniae infections. Since the implementation of routine PCV7 immunization in 2000, invasive infections have decreased yearly from 2001 through 2004, to a nadir of 151 infections; the rate then increased from 2005 through 2008. Compared with the pre-PCV7 era, a greater proportion of children with invasive pneumococcal infection had an underlying condition in the post-PCV7 period. Compared with the total number of annual admissions, the number of 19A isolates increased significantly from 2001 to 2008 (P < .00001). In 2007 and 2008, only 16 isolates (4%) were vaccine serotypes; 19A accounted for 46% (168 of 369) of the non-PCV7 serotypes. Thirty percent of the 19A isolates were multidrug resistant. Serotypes 1, 3, and 7F accounted for 22% of the non-PCV7 serotypes. Among children with invasive pneumococcal infections, the likelihood of a 19A serotype increased with the number of preceding PCV7 doses. Since 2005, the number of invasive pneumococcal infections in children has increased at 8 children's hospitals, primarily as a result of serotype 19A isolates, one third of which were resistant to multiple antibiotics in 2007 and 2008. Continued surveillance is necessary to detect emerging serotypes after the planned introduction of 13-valent or other pneumococcal vaccines.

Pneumococcal Vaccination at Disease Onset: New Strategies of Protection Against Pneumococcal Infection in Children with Idiopathic Nephrotic Syndrome

Children with idiopathic nephrotic syndrome are at risk of potentially severe pneumococcal infections, such as pneumonia, meningitis and peritonitis. This susceptibility is due to losses of immunoglobulin and complement system components. Strategies to reduce the risk of pneumococcal infections include antibiotic prophylaxis (abandoned as a result of an increased risk to select resistant strains) and antipneumococcal vaccination. Traditionally, vaccination was performed when the patient was in remission and on low-dose steroids. A recent study has demonstrated that nephrotic children on high-dose glucocorticoid therapy respond to a pneumococcal polysaccharide vaccine. The major advantage of this strategy is that patients who relapse during the tapering of steroids already have increased anti-pneumococcal antibodies at the time of relapse. Patients with steroid-dependent or -resistant forms of the nephrotic syndrome acquire high antibody levels even if early relapses delay the tapering of steroids or if immunosuppressive agents are introduced. The fear of vaccine-induced relapses creates hesitation concerning vaccination of children with idiopathic nephrotic syndrome in remission. 23-valent pneumoccal vaccine at disease onset may therefore increase the number of pneumococcal vaccinations in children with the nephrotic syndrome. Vaccination with a 23-valent pneumoccal vaccine at disease onset while the patient is proteinuric and on high-dose steroids is a safe strategy with a high antibody response.

Pneumococcal serology in children’s respiratory infections

The role of Streptococcus pneumoniae in the etiology of respiratory tract infections has been studied serologically using microbe-specific antibody and immune complex assays. Serological methods are sensitive in the bacteremic pneumococcal pneumonia of adults. In children, however, pneumococcal pneumonia is seldom bacteremic, and, thus, in the absence of a gold standard for the detection of pneumococcal infection, serological methods are still insufficiently validated. We report here indirect evidence for the sensitivity and specificity of pneumococcal serology in children. Serological evidence of pneumococcal infection has been found in 27% to 38% of children with radiologically confirmed pneumonia, in 7% to 8% of children with viral wheezy bronchitis, and in <1% to 5% of children and young adults with viral upper respiratory infection. Serological findings for pneumococcal infection have been dependent on the study venue, whether in hospital or ambulatory subjects, and on the test panel used. Where both antibody and immune complex assays have been available, the proportion of children with pneumococcal infection has been 32% to 37% in inpatients and 27% to 28% in outpatients. The respective rates have been 10% to 18% by antibody assays alone. Pneumococcal acute otitis media, when present with pneumonia, may confound findings in pneumococcal serology, but pure nasopharyngeal carriage of S. pneumoniae has little effect. In contrast, carriage acquisition of a new serotype may induce significant antibody production. Thus, understandably, significant rises between paired sera in antibodies to pneumococcal capsular polysaccharides and pneumococcal pneumolysin have been found in <1% to 3% of non-symptomatic children and young adults. Findings from the last 20 years indirectly suggest that pneumococcal antibody and immune complex assays are sensitive and specific enough for the detection of pneumococcal infection in children. However, the methods are too complex for routine clinical practice, and, so far, serological methods for S. pneumoniae infections have only been used for research purposes.

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

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.

Summary of ‘Prophylactic antibiotics for preventing pneumococcal infection in children with sickle cell disease’

AbstractThis is a summary of a Cochrane review, published in this issue of EBCH, first published as: Hirst C, Owusu‐Ofori S. Prophylactic antibiotics for preventing pneumococcal infection in children with sickle cell disease. Cochrane Database of Systematic Reviews 2002, Issue 3. Art. No.: CD003427. DOI: 10.1002/14651858.CD003427.Further information for this Cochrane review is available in this issue of EBCH in the accompanying Commentary and Characteristics and Key Findings Tables articles. Copyright © 2007 The Cochrane Collaboration. Published by John Wiley &amp; Sons, Ltd. The Cochrane Collaboration

Commentary on ‘Prophylactic antibiotics for preventing pneumococcal infection in children with sickle cell disease’

AbstractThis is a commentary on a Cochrane review, published in this issue of EBCH, first published as: Hirst C, Owusu‐Ofori S. Prophylactic antibiotics for preventing pneumococcal infection in children with sickle cell disease. Cochrane Database of Systematic Reviews 2002, Issue 3. Art. No.: CD003427. DOI: 10.1002/14651858.CD003427.Further information for this Cochrane review is available in this issue of EBCH in the accompanying EBCH Summary and Characteristics and Key Findings Tables articles. Copyright © 2007 The Cochrane Collaboration. Published by John Wiley &amp; Sons, Ltd. The Cochrane Collaboration

Characteristics and key findings for ‘Prophylactic antibiotics for preventing pneumococcal infection in children with sickle cell disease’

AbstractThese are the characteristics and key findings for a Cochrane review, published in this issue of EBCH, first published as: Hirst C, Owusu‐Ofori S. Prophylactic antibiotics for preventing pneumococcal infection in children with sickle cell disease. Cochrane Database of Systematic Reviews 2002, Issue 3. Art. No.: CD003427. DOI: 10.1002/14651858.CD003427.Further information for this Cochrane review is available in this issue of EBCH in the accompanying EBCH Summary and Commentary articles. Copyright © 2007 The Cochrane Collaboration. Published by John Wiley &amp; Sons, Ltd. The Cochrane Collaboration