Questionnaire Aids in Evaluating Antibiotic Prophylaxis Use in Children with Sickle Cell Disease

Malika Ammam, PhD avatar

by Malika Ammam, PhD |

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IMR-687, sickle cell disease

Researchers developed an evaluation method that accurately and comprehensively assesses antibiotic prophylaxis adherence in children with sickle cell disease (SCD). The study, “A validated measure of adherence to antibiotic prophylaxis in children with sickle cell disease,” was published in Patient Preference and Adherence.

SCD, a genetic disorder that alters the hemoglobin shape, may lead to organ damage such as enlarged spleen due to the reduced oxygen levels in the body. Children with SCD are particularly at risk of compromised splenic function, which rises rates of the presence of bacteria in their blood (bacteremia).

As a measure of prevention of infection and treatment, antibiotics based on penicillin prophylaxis are often utilized in SCD children. “With the implementation of prophylactic antibiotic prescribing, the risk of bacteremia in febrile children with SCD has decreased from 3%–5%, as documented from 1975 to 2002, to <1%,” the researchers, at the Indiana University School of Medicine Riley and Child Adolescent Psychiatry Clinic, wrote.

Despite penicillin’s effectiveness, adherence to the twice-daily treatment regimen is problematic and estimated at only 66 percent. Consequently,  the researchers aimed to develop and validate a Sickle Cell Antibiotic Adherence Level Evaluation (SCAALE) method to facilitate the systematic and detailed evaluation of drug adherence in SCD children.

They utilized a 28-item questionnaire, covering a total of seven adherence areas. The validation measures were essentially based on the assessment of General Adherence Ratings estimated from the parent, one healthcare provider, and ratios of drugs possession.

Results suggested high consistency (very good to excellent) for both the total evaluated SCAALE and four of the seven subscales. Furthermore, strong correlations were recorded between SCAALE scores and the validation measures for both the total SCAALE and five of the seven subscales.

“The SCAALE provides the first detailed, quantitative, dimensional, and global measurement of adherence to antibiotic prophylaxis in SCD. Evidence from this study supports the reliability and validity of the overall 28-question scale and of most subscales. Development of this scale represents an important contribution to pediatric SCD with clear applicability to clinical management, research programs, and state-funded NBS initiatives,” the authors concluded.