Bacterial infection is a major cause of morbidity and mortality in patients with sickle cell disease. Loss of splenic function is an important risk factor, increasing the susceptibility to encapsulated organisms. A prophylactic strategy using both vaccinations and antibiotic therapy can significantly reduce the risk of infection, especially in children.
Most important pathogens:
(1) Streptococcal pneumoniae
(2) Hemophilus influenzae
(3) Salmonella species
(4) Staphylococcus aureus
(5) E. coli (associated with urosepsis_
The conjugate heptavalent pneumococcal vaccine is effective in children under 2 years of age. The dosage schedule varies with age (see page 127, Gilbert et al):
(1) infants <= 6 months: 4 doses
(2) 7 – 11 months: 3 doses
(3) 12 – 23 months: 2 doses
(4) >= 24 months: 2 doses
Hemophilus influenzae type b conjugate vaccine: Administered in 4 doses from 2 to 15 months of age.
Meningococcal polyvalent vaccine is recommended, but I cannot find a recommendation for at what age to administer it. It probably should be administered after age 2.
Children and adults should receive the influenza vaccine each season.
Since pneumococcal vaccine is not completely protective, young children usually receive antibiotic prophylaxis.
(1) 3 months to 5 years: amoxicillin 125 mg po bid
(2) > 5 years: penicillin V 250 mg po bid
If the patient has a penicillin allergy, erythromycin (Erythrocin) may be used.
NOTE: I cannot find reference to use of prophylactic antibiotics in adults. The risk of infection declines as the person becomes older. However, the likelihood of being functionally asplenic is greater in the adult. If the person has evidence of asplenia, a suitable regimen should be used (see section above on the asplenic patient).
