Use Of Penicillin Prophylaxis Research Articles

Participation in research improves overall patient management: insights from the Global Rheumatic Heart Disease registry (REMEDY).

SummaryBackgroundRheumatic heart disease (RHD) is a major public health problem in low– and middle–income countries (LMICs), with a paucity of high–quality trial data to improve patient outcomes. Investigators felt that involvement in a recent large, observational RHD study impacted positively on their practice, but this was poorly defined.AimThe purpose of this study was to document the experience of investigators and research team members from LMICs who participated in a prospective, multi–centre study, the global Rheumatic Heart Disease Registry (REMEDY), conducted in 25 centres in 14 countries from 2010 to 2012. MethodsWe conducted an online survey of site personnel to identify and quantify their experiences. Telephone interviews were conducted with a subset of respondents to gather additional qualitative data. We asked about their experiences, positive and negative, and about any changes in RHD management practices resulting from their participation in REMEDY as a registry site.ResultsThe majority of respondents in both the survey and telephone interviews indicated that participation as a registry site improved their management of RHD patients. Administrative changes included increased attention to follow–up appointments and details in patient records. Clinical changes included increased use of penicillin prophylaxis, and more frequent INR monitoring and contraceptive counselling.ConclusionsOur study demonstrates that participation in clinical research on RHD can have a positive impact on patient management. Furthermore, REMEDY has led to increased patient awareness and improved healthcare workers’ knowledge and efficiency in caring for RHD patients.

Prevalence of Complications of Sickle Cell Disease at Makkah Al-Mukaramah, Saudi Arabia, 2017

Background: The studies in the Middle East Arabs have found that there are specific risk factors making Sickle cell disease (SCD) more prevalent in that part of the world, which has the fast growing in the population and the increase in consanguinity marriage. Despite of that, there are no studies conducted in Makkah Al-Mukarramah or even in all Saudi Arabia (KSA) regions that, focusing on the complications of SCD and its related risk factors. Objectives: To determine the pattern of admission and estimate the prevalence of different complications of SCD among children in Makkah Al-Mukaramah, KSA, 2017. Patients and methods: A retrospective, analytic, noninterventional cohort study was carried out in Makkah Al- Mukaramah, KSA over a 6 months period (from first of June 2017 to end of December 2017). The study reviewed the medical files of all sickler patients who have been admitted to the pediatric departments of the involved hospitals in the given time. Records of patients having combined thalassemia disease and/or Glucose 6 Phosphate Dehydrogenase Deficiency (G6PD) were excluded from the study. The required data were collected by using hard copies of a well-designed, semi-structured, valid and reliable checklist. Results: The study included 145 medical files of pediatric patients with SCD. Their age ranged between one day to 14 years with a Mean ± SD of 7 ± 3.6 years. Males represent 54.5% of them. Almost two-thirds of patients (67.6%) were Saudis. All cases live outside Makkah (n=5) were diagnosed as Sickle cell anemia with Vaso-occlusive crisis (VOC) whereas 47.1% of those live in Makkah were diagnosed by VOC at admission. The most frequent complication was VOC (55.9%), followed by infection (9%). Overall, 41.4% of SCA pediatric patients were admitted once whereas 25.5% were admitted more than 5 times. Acute splenic sequestration crisis was reported among 3.1% of Saudi patients compared to 12.8% of non-Saudi patients. This difference was statistically significant. Other complications were not significantly related to patients` nationality. Conclusion: The most frequent complication of SCD was VOC. Primary prevention of the acute complications of SCD should base on health care provider with expertise in SCD, preferably hematologist. In addition to prevention of complications through the use of penicillin prophylaxis started in the newborn period, appropriate immunizations, and blood transfusions for those at risk for stroke.

How we prevent and manage infection in sickle cell disease.

Sickle cell disease (SCD) affects approximately 100,000 people in the US, 12,500 in the UK, and millions worldwide. SCD is typified by painful vaso-occlusive episodes, haemolytic anaemia and organ damage. A secondary complication is infection, which can be bacterial, fungal or viral. Universal newborn screening, routine use of penicillin prophylaxis, availability of conjugated vaccines against S. pneumoniae and comprehensive care programmes instituted during the past few decades in industrialized countries have dramatically reduced childhood mortality and improved life expectancy. Yet patients with SCD remain at increased risk of infection. Unfortunately, the treatment of most bacterial infections that are common in SCD is not based on the results of randomized controlled clinical trials. In their absence, treatment decisions are based on consensus guidelines, clinical experience or adapting treatment applied in other diseases. This leads to wide variation in treatment among institutions and even between treating physicians in a single institution. Prevention of infection, when possible, is most important and we focus on prevention through targeted prophylaxis and vaccination. We will share our management strategies for managing the more common infections in SCD and provide the rationale for our recommendations.

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

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.

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.

Penicillin Prophylaxis in Children with Sickle Cell Disease

Children who have sickle cell disease and are under the age of five years are at increased risk of life-threatening pneumococcal infection due to absent or non-functional spleens and a decreased immune response. To prevent pneumococcal infection, the American Academy of Pediatrics recommends the use of penicillin prophylaxis in children with sickle cell disease under the age of five and in older children who have had a previous severe pneumococcal infection or have functional/surgical asplenia. These recommendations are based on two landmark studies, the first evaluating the effectiveness of penicillin prophylaxis and the second evaluating the duration of prophylaxis. Although the mortality rate from infection has been reduced following penicillin prophylaxis, altered immunologic response and penicillin-resistant S. pneumoniae remain a concern. This paper will review the literature that supports the use of penicillin prophylaxis, potential problems associated with prolonged therapy and recommendations for prophylaxis.

The Effect of the Pneumococcal Conjugate Vaccine on Children with Sickle Cell Disease

The Effect of the Pneumococcal Conjugate Vaccine on Children with Sickle Cell Disease

The Genomics of New Drugs in Sickle Cell Disease

The quality of life of patients with sickle cell disease in developed countries has improved significantly over the past two decades. Currently available measures to prevent the painful crises and the complications of the disease include the use of penicillin prophylaxis, antipneumonococcal vaccine, folate administration, chronic red cell transfusions in patients with cerebrovascular disease, iron chelating agents, fetal hemoglobin-enhancing agents, such as hydroxyurea, decitabine and butyrate, drugs that augment the endogenous nitric oxide levels and agents that restore red cell dehydration. Sickle cell patients show a broad phenotypic expression and a great variability in treatment response. Genetic association studies, which attempt to link polymorphisms with certain disease phenotypes and drug response, are taking the first steps in aiding individualized therapy in sickle cell patients in order to enhance efficacy and reduce toxicity.

Poststreptococcal Reactive Arthritis in Adults: A Case Series

Objective To guide primary care physicians regarding the diagnosis and treatment of poststreptococcal reactive arthritis (PSReA) in adults. Patients and Methods We retrospectively reviewed an indexed database of all patients evaluated or hospitalized between 1976 and 1998 at Mayo Clinic Rochester and identified 35 patients with the diagnosis of reactive streptococcal arthritis, arthralgia, or arthritides. Twenty-nine patients with the diagnosis of acute rheumatic fever (ARF), septic streptococcal arthritis, or nonspecific reactive arthritis were excluded. Results PSReA was confirmed in 6 adults (3 women, 3 men; age range, 25–66 years). All patients were symptomatic with polyarthritis and oligoarthritis disproportionate to the objective findings on physical examination. Although all patients had negative throat cultures at the onset of arthritis, increased titers of anti-DNase B and antistreptolysin O confirmed recent streptococcal infection. Antecedent events included pharyngitis in 3 patients (who had received a minimum of a 10-day course of penicillin) and toxic shock syndrome in 1 patient. The latency of onset of arthritis ranged from 4 days to 6 weeks. The arthritic symptoms had a protracted course beyond the typical maximum of 3 weeks described for ARF. Treatment with aspirin did not provide symptomatic relief in any of the patients, whereas the response to therapy with nonsteroidal anti-inflammatory drugs (NSAIDs) was at least partial in all cases. Symptomatic relief occurred in 1 patient who received indomethacin and in 1 patient treated with prednisone. Penicillin prophylaxis was recommended in 1 patient. Conclusion PSReA should be included in the differential diagnosis of all adult patients presenting with arthritis. Treatment strategies include aspirin, other NSAIDs, and corticosteroids. In adult patients with PSReA, there is no evidence to support the use of penicillin prophylaxis at this time. To guide primary care physicians regarding the diagnosis and treatment of poststreptococcal reactive arthritis (PSReA) in adults. We retrospectively reviewed an indexed database of all patients evaluated or hospitalized between 1976 and 1998 at Mayo Clinic Rochester and identified 35 patients with the diagnosis of reactive streptococcal arthritis, arthralgia, or arthritides. Twenty-nine patients with the diagnosis of acute rheumatic fever (ARF), septic streptococcal arthritis, or nonspecific reactive arthritis were excluded. PSReA was confirmed in 6 adults (3 women, 3 men; age range, 25–66 years). All patients were symptomatic with polyarthritis and oligoarthritis disproportionate to the objective findings on physical examination. Although all patients had negative throat cultures at the onset of arthritis, increased titers of anti-DNase B and antistreptolysin O confirmed recent streptococcal infection. Antecedent events included pharyngitis in 3 patients (who had received a minimum of a 10-day course of penicillin) and toxic shock syndrome in 1 patient. The latency of onset of arthritis ranged from 4 days to 6 weeks. The arthritic symptoms had a protracted course beyond the typical maximum of 3 weeks described for ARF. Treatment with aspirin did not provide symptomatic relief in any of the patients, whereas the response to therapy with nonsteroidal anti-inflammatory drugs (NSAIDs) was at least partial in all cases. Symptomatic relief occurred in 1 patient who received indomethacin and in 1 patient treated with prednisone. Penicillin prophylaxis was recommended in 1 patient. PSReA should be included in the differential diagnosis of all adult patients presenting with arthritis. Treatment strategies include aspirin, other NSAIDs, and corticosteroids. In adult patients with PSReA, there is no evidence to support the use of penicillin prophylaxis at this time.

Poststreptococcal Reactive Arthritis in Adults: A Case Series

To guide primary care physicians regarding the diagnosis and treatment of poststreptococcal reactive arthritis (PSReA) in adults. We retrospectively reviewed an indexed database of all patients evaluated or hospitalized between 1976 and 1998 at Mayo Clinic Rochester and identified 35 patients with the diagnosis of reactive streptococcal arthritis, arthralgia, or arthritides. Twenty-nine patients with the diagnosis of acute rheumatic fever (ARF), septic streptococcal arthritis, or nonspecific reactive arthritis were excluded. PSReA was confirmed in 6 adults (3 women, 3 men; age range, 25-66 years). All patients were symptomatic with polyarthritis and oligoarthritis disproportionate to the objective findings on physical examination. Although all patients had negative throat cultures at the onset of arthritis, increased titers of anti-DNase B and antistreptolysin O confirmed recent streptococcal infection. Antecedent events included pharyngitis in 3 patients (who had received a minimum of a 10-day course of penicillin) and toxic shock syndrome in 1 patient. The latency of onset of arthritis ranged from 4 days to 6 weeks. The arthritic symptoms had a protracted course beyond the typical maximum of 3 weeks described for ARF. Treatment with aspirin did not provide symptomatic relief in any of the patients, whereas the response to therapy with nonsteroidal anti-inflammatory drugs (NSAIDs) was at least partial in all cases. Symptomatic relief occurred in 1 patient who received indomethacin and in 1 patient treated with prednisone. Penicillin prophylaxis was recommended in 1 patient. PSReA should be included in the differential diagnosis of all adult patients presenting with arthritis. Treatment strategies include aspirin, other NSAIDs, and corticosteroids. In adult patients with PSReA, there is no evidence to support the use of penicillin prophylaxis at this time.

Pneumococcal colonization in children with sickle cell disease

OBJECTIVE: The goals of this prospective study were to define the Streptococcus pneumoniae colonization rate in children with sickle cell disease (SCD) at the Children's Hospital of Philadelphia and to determine the serotype and antibiotic susceptibility of all isolates. METHODS: Children with SCD followed at the hospital were sampled for colonization with S. pneumoniae by means of a throat or nasopharyngeal swab on one or two occasions. Patient information was obtained when the specimen was collected. Specimens were isolated on gentamicin-blood agar plates and modified Avery broth. Antibiotic susceptibility was determined by a commercially available test (E-test). Isolates were serotyped with the use of type-specific antisera. The relationship between the data noted above and certain clinical parameters was examined. RESULTS: A total of 490 specimens were obtained from 278 patients. Twenty-eight patients had a culture positive for S. pneumoniae, resulting in an overall colonization rate of 10%. Thirty-three percent (11/33) of all isolates were resistant to penicillin–seven intermediately resistant and four highly resistant. Twelve percent of isolates were also resistant to cefotaxime. Eight different serotypes were identified; all but one are included in the current 23-valent pneumococcal vaccine. Penicillin prophylaxis did not increase the rate of colonization with resistant strains of pneumococcus. CONCLUSION: Our results do not support a change in the current use of penicillin prophylaxis nor in the acute management of the febrile child with SCD. (J Pediatr 1996;129:821-7)

Food-borne outbreak of streptococcal pharyngitis in an Israeli Airforce Base.

A food-borne outbreak of group A beta hemolytic streptococcus (GAS) pharyngitis occurred in an Israeli airforce base between 15 and 18 April, 1992. An epidemiologic investigation was conducted in a random sample of the base personnel. The effectiveness of prophylactic administration of penicillin to healthy individuals during the outbreak in preventing secondary spread of the disease was evaluated. 197 patients with pharyngitis were seen at the base clinic during the outbreak. The epidemiologic investigation indicated that the outbreak was food-borne. Consumption of processed white cheese that had been prepared without using a proper hand washing technique, 24 h before lunch on 15 April 1992, and subsequently kept at room temperature for 5 h, was significantly associated with GAS infection of the epidemic strain (p < 0.05). The food handler who processed the cheese had anterior cervical lymphadenopathy and GAS T type 8/25/Imp19 (the epidemic type) was found in his throat culture. The secondary respiratory attack rate among the healthy base personnel (n > 1,000) was 1.6%. 40 base personnel were treated by penicillin prophylaxis and had a secondary attack rate of 0%. The medical personnel who were on duty during the outbreak had a secondary attack rate of 75% (p < 0.001). The use of penicillin prophylaxis did not have an advantage in preventing secondary respiratory spread of streptococcal pharyngitis. Penicillin prophylaxis might reduce the high secondary attack rate of the disease in risk groups such as the medical personnel.

The development of penicillin-resistant oral streptococci after repeated penicillin prophylaxis

Oral streptococci may cause infective endocarditis in patients with susceptible cardiac disease after dental treatment. Multiple dental visits, each preceded by penicillin prophylaxis, may result in the unwanted development of resistant oral streptococci. This study was undertaken to determine whether resistant oral streptococci would develop after the repeated use of penicillin prophylaxis in healthy adults. Plaque samples were collected from 20 subjects on each Monday for 5 successive weeks. Each subject was administered 2 gm penicillin V followed by 1 gm 6 hours later (standard prophylaxis regimen of the American Heart Association), on three successive Mondays (weeks 2, 3, and 4). The total cultivable oral streptococci and penicillin-resistant oral streptococci were determined for each plaque sample, and representative colonies of resistant streptococci were speciated. During the study, there was a significant increase in the number of subjects who harbored penicillin-resistant oral streptococci. However, with the exception of one subject who had resistant streptococci throughout the study, the number of resistant strains represented only 0.0003% to 0.41% of the total cultivable oral streptococci.

CARE OF INFANTS WITH DISEASE: THE ULTIMATE OBJECTIVE OF NEWBORN SCREENING

We conclude that newborn screening with a comprehensive follow-up program, emphasizing parental education and the use of penicillin prophylaxis, is effective in reducing morbidity and mortality from pneumococcal infections in infants with sickle cell disease. One of the 159 infants followed-up during 1981 to 1986 died as a result of overwhelming sepsis. This compares with an anticipated mortality rate at that time of 10%. Penicillin prophylaxis should be started at 3 months of age in infants with Hb SS and should also be given to infants with hemoglobin SC and S- β-thalassemia. The duration for which prophylaxis must be given is not known, but it should be continued at least through the age of 5 years. Monthly injections of benzathine penicillin is an inadequate regimen; we recommend that, if penicillin is to be administered by the intramuscular route, it should be given every 3 weeks and supplemented in the last week with oral penicillin. However, we now emphasize that the daily oral administration of penicillin is the preferred method of administration for prophylaxis. Pneumococcal vaccine continues to be given at 2 years of age, with a booster dose recommended at 4 to 5 years of age. H influenzae vaccine conjugates are immunogenic when given at 18 months, and newer vaccines may soon be available that can be given much earlier. Finally, and most important, the program must be structured in such a way as to thoroughly involve the parents in assuming responsibility for their child's continued health and well being.

Acute chest syndrome in sickle cell disease: Etiology and clinical correlates

Acute chest syndrome (ACS) is a new pulmonic process in a clinically ill patient with sickle cell disease. We prospectively analyzed 102 episodes of ACS in patients in our hospital during a 2-year period to study cause and clinical correlates. In 12% of the episodes, ACS was judged to be secondary to bacterial pneumonia (including only 3% secondary to Streptococcus pneumoniae), 8% was associated with uncomplicated viral pneumonias, and 16% with mycoplasmal pneumonias. The clinical course and seasonal variations in these groups were compared with those in the remaining 64% of episodes. In comparison with episodes of ACS of undetermined origin (presumably secondary to pulmonary infarct, atelectasis, or missed infections), patients with bacterial pneumonia were sicker, as shown by fever and hospitalization of longer duration, the percent of those requiring red blood cell transfusion, and the presence of pleural effusions. The lower incidence of bacterial pneumonias among our patients compared with that previously reported may reflect our use of penicillin prophylaxis and pneumococcal immunization to prevent S. pneumoniae infections.