Antibiotics and vaccination in sickle cell disease

Prophylaxis with daily oral penicillin reduces the rate of pneumococcal infection and the mortality rate (1)

Prophylaxis should commence by the age of 3 months (when the level of fetal haemoglobin starts to reduce & the risk of splenic hypofunction increases) and should be continued throughout childhood (2).

Recommended doses of oral penicillin are (erythromycin may be used in patients with penicillin allergy):

• 62.5 mg daily up to age 1 year
• 125 mg daily up to age 3 year
• 250 mg daily thereafter (2)

Pneumococcal vaccination should be given as soon as possible after diagnosis (1)

• a conjugated pneumococcal polysaccharide vaccine - this is immunogenic in the very young and is licensed for use in the under 6 month old
• 23-valent polysaccharide vaccine - only weakly immunogenic in children under 2 years old - should be used in older children
  • usually at 2-3 years old, then every 5 years

All the other vaccines in the routine infant immunisation programme should be given:

• hepatitis B immunisation should also be offered to non immune children (2)
• children should also be immunised each autumn against influenza

Reference:

• (1) Drug and Therapeutics Bulletin (2001), 39 (5), 33-37.
• (2) NHS Antenatal and Newborn Screening Programmes 2010. Sickle cell disease in childhood: standards and guidelines for clinical care