Prophylactic Penicillin for Children With Sickle Cell Disease

Sickle cell disease or sickle cell anemia is an inherited disease in which the red blood cells are abnormally shaped like crescent moons or sickles and are sticky and rigid. These red blood cells then slow or block blood in the vessels, preventing oxygen and blood to flow normally to other parts of the body. There is no cure, but it is treatable, and prophylactic penicillin is a standard of care for children under 5 years of age to prevent deadly infections.

Infection Risks

• Sickle cell disease patients are particularly vulnerable to infection. According to the Journal of the American Medical Association (JAMA), children with sickle cell disease have a 20- to 100-fold higher rate of incidence of Streptococcus pneumoniae than the general population.

Prevention/Solution

• According to JAMA, prophylactic or preventative penicillin reduces the risk of pneumococcal infection by 84 percent, whether or not they have been immunized for the illness.

Recommendations

• The American Academy of Family Physicians recommends that all children with sickle cell disease receive prophylactic penicillin starting at 2 months of age, or at time of diagnosis, and continuing until age 5.

Dosing

• The recommendation is for daily penicillin V potassium (Veetids) or, if necessary, substituting intramuscular penicillin G benzathine (Bicillin L-A) every three weeks.

Discontinuing

• The daily penicillin prophylactic medication for sickle cell can be discontinued at age 5, so long as there has been no incidence of pneumococcal infections or spleen problems.

Significance

• According to the American Academy of Family Physicians, prophylactic penicillin treatment for children has played a major role in the dramatic increase in life expectancy with sickle cell disease, from 14 years to nearly 50, in the course of one generation.