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March 1987

Penicillin in Sickle Cell Anemia: A Panacea for the Lost Spleen?

Author Affiliations

Department of Pediatrics Division of Hematology/Oncology University of Southern California School of Medicine 1200 N State St Los Angeles, CA 90033; Department of Pediatrics University of California at Los Angeles Olive View Medical Center 7533 Van Nuys Blvd Suite 301 S Tower Van Nuys, CA 91405

Am J Dis Child. 1987;141(3):250-252. doi:10.1001/archpedi.1987.04460030028017

Ideally, antibiotic prophylaxis should prevent disease caused by virulent organisms in immunodeficient patients. Antibiotics may interrupt the initial nasopharyngeal colonization or prevent the primary bacteremia and ensuing metastatic infection. The predilection for severe and frequent pneumococcal infections in children with sickle cell anemia, the critical link to the early loss of splenic function, and the age-adjusted prevalence rates have been amply emphasized by previous investigations.1-3 Unaccountably, the risk of pneumococcal septicemia is much higher in the young child with sickle cell anemia than in children of comparable age who have undergone simple splenectomy. In children with sickle cell anemia, the risk of pneumococcal septicemia is highest before the age of 3 years. Unfortunately, this is the same age at which multivalent pneumococcal vaccines do not reliably induce protective antibodies. Furthermore, in young children, it is not clear whether vaccines alter the nasopharyngeal carrier rate.3 Thus, the pneumococcal vaccines

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