Antibiotic Preventive Treatment Rates for IPD Very Low Among Sickle Cell Children, Study Says

Despite an increased risk of invasive pneumococcal disease (IPD) in children with sickle cell anemia (SCA), preventive treatment (prophylaxis) rates remain low among these patients, a study shows.

The research, “Antibiotic Prophylaxis for Children With Sickle Cell Anemia,” was published in Pediatrics, the official journal of the American Academy of Pediatrics. The work was carried out at the University of Michigan.

Streptococcus pneumoniae (pneumococcus) is a type of bacteria that can cause infections of the ears, sinuses, or lungs. It also can cause more serious infections of the blood or brain, called IPD.

The National Heart, Lung, and Blood Institute (NHLBI) recommends administering penicillin (antibiotic) to sickle cell children until the age of 5, twice a day, which significantly reduces the risk of IPD.

Nonetheless, a limited number of studies have shown that few children get the recommended course of preventive treatment.

To shed additional light on the matter, and because previous studies did not focus on the NHLBI-target population of children with sickle cell, scientists sought to assess antibiotic prophylaxis using different sets of antibiotics within this specific patient sample. One of the goals was to identify possible opportunities for intervention.

Data was collected from antibiotics receipts identified through Medicaid claims for filled prescriptions in six U.S. states with an average to high prevalence of sickle cell: Florida, Illinois, Louisiana, Michigan, South Carolina, and Texas.

Only 18 percent of the 2,821 children (3 months to 5 years of age) studied receive antibiotic treatment for more than 300 days, even when other preventive treatment options were considered, i.e., other antibiotics rather than penicillin.

This is of particular concern because these patients are at high risk of IPD or death, even with the introduction of the pneumococcal conjugate vaccine, which helps to prevent pneumococcal disease in infants and toddlers.

One of this study’s limitations is that “the presence of a filled antibiotic prescription does not necessarily indicate that the medication actually was administered to the patient for whom it was prescribed. This limitation suggests that our results may be an overestimate of the true proportion of children with SCA protected against IPD,” the team said.

Researchers found that the odds of a child with sickle cell anemia receiving antibiotic treatment for more than 300 days slightly increased with more healthcare visits.

They believe that “given the consistent finding that antibiotic prophylaxis rates are low among children with SCA, development of practical and effective interventions are key. These interventions should be focused at both the provider and the patient and parent level to ensure a more comprehensive approach to reducing the barriers associated with antibiotic prophylaxis among this population.”