Antibiotic Prophylaxis for Children With Sickle Cell Anemia.

Abstract

BACKGROUND:

Children with sickle cell anemia (SCA) are at increased risk for invasive pneumococcal disease; antibiotic prophylaxis significantly reduces this risk. We calculated the proportion of children with SCA who received ≥300 days of antibiotic prophylaxis and identified predictors of such receipt.

METHODS:

Children aged 3 months to 5 years with SCA were identified by the presence of 3 or more Medicaid claims with a diagnosis of SCA within a calendar year (2005-2012) in Florida, Illinois, Louisiana, Michigan, South Carolina, and Texas. Receipt of antibiotics was identified through claims for filled prescriptions. The outcome, receipt of ≥300 days of antibiotics, was assessed annually by using varying classifications of antibiotics. By using logistic regression with generalized estimating equations, we estimated the odds of receiving ≥300 days of antibiotics, with potential predictors of age, sex, year, state, and health services use.

RESULTS:

A total of 2821 children contributed 5014 person-years. Overall, only 18% of children received ≥300 days of antibiotics. Each additional sickle cell disease-related outpatient visit (odds ratio = 1.01, 95% confidence interval: 1.01-1.02) and well-child visit (odds ratio = 1.08, 95% confidence interval: 1.02-1.13) was associated with incrementally increased odds of receiving ≥300 days of antibiotics.

CONCLUSIONS:

Despite national recommendations and proven lifesaving benefit, antibiotic prophylaxis rates are low among children with SCA. Numerous health care encounters may offer an opportunity for intervention; in addition, such interventions likely need to include social factors that may affect the ability for a child to receive and adhere to antibiotic prophylaxis.

• Authors: Sarah L Reeves, Alison C Tribble, Brian Madden, Gary L Freed, Kevin J Dombkowski
• Journal: Pediatrics (Pediatrics) Vol. 141 Issue 3 (03 2018) ISSN: 1098-4275 [Electronic] United States
• PMID: 29437860 (Publication Type: Journal Article, Research Support, U.S. Gov't, P.H.S.)
• Copyright: Copyright © 2018 by the American Academy of Pediatrics.

Topics

• Anemia, Sickle Cell (microbiology)
• Antibiotic Prophylaxis (statistics & numerical data)
• Child, Preschool
• Drug Utilization
• Female
• Guideline Adherence
• Humans
• Infant
• Male
• Medication Adherence
• Pneumococcal Infections (prevention & control)
• Practice Guidelines as Topic
• Risk Factors
• United States