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Discontinuing penicillin prophylaxis in children with sickle cell anemia. Prophylactic Penicillin Study II.

Publication ,  Journal Article
Falletta, JM; Woods, GM; Verter, JI; Buchanan, GR; Pegelow, CH; Iyer, RV; Miller, ST; Holbrook, CT; Kinney, TR; Vichinsky, E
Published in: J Pediatr
November 1995

OBJECTIVE: To evaluate the consequences of discontinuing penicillin prophylaxis at 5 years of age in children with sickle cell anemia who had received prophylactic penicillin for much of their lives. DESIGN: Randomized, double-blind, placebo-controlled trial. SETTING: Eighteen teaching hospitals throughout the United States. PATIENTS: Children with sickle cell anemia (hemoglobin SS or hemoglobin S beta 0-thalassemia) who had received prophylactic penicillin therapy for at least 2 years immediately before their fifth birthday and had received the 23-valent pneumococcal vaccine between 2 and 3 years of age and again at the time of randomization. Of 599 potential candidates, 400 were randomly selected and followed for an average of 3.2 years. INTERVENTIONS: After randomization, patients received the study medication twice daily--either penicillin V potassium, 250 mg, or an identical placebo tablet. Patients were either seen in the clinic or contacted every 3 months thereafter for an interval history and dispensing of the study drug. A physical examination was scheduled every 6 months. MAIN OUTCOME MEASURES: The primary end point was a comparison of the incidence of bacteremia or meningitis caused by Streptococcus pneumoniae in children continuing penicillin prophylaxis versus those receiving the placebo. RESULTS: Six children had a systemic infection caused by S. pneumoniae, four in the placebo group (2.0%; 95% confidence interval 0.5%, 5.0%) and two in the continued penicillin prophylaxis group (1.0%; 95% confidence interval 0.1%, 3.6%) with a relative risk of 0.5 (95% confidence interval 0.1, 2.7). All invasive isolates were either serotype 6(A or B) or serotype 23F. Four of the isolates were penicillin susceptible, and two (one from each treatment group) were penicillin and multiply antibiotic resistant. Adverse effects of the study drug were reported for three patients (nausea, vomiting, or both), one of whom was in the placebo group. CONCLUSION: Children with sickle cell anemia who have not had a prior severe pneumococcal infection or a splenectomy and are receiving comprehensive care may safely stop prophylactic penicillin therapy at 5 years of age. Parents must be aggressively counseled to seek medical attention for all febrile events in children with sickle cell anemia.

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Published In

J Pediatr

DOI

ISSN

0022-3476

Publication Date

November 1995

Volume

127

Issue

5

Start / End Page

685 / 690

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Time Factors
  • Streptococcus pneumoniae
  • Pneumococcal Infections
  • Penicillins
  • Pediatrics
  • Meningitis, Pneumococcal
  • Male
  • Humans
 

Citation

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Falletta, J. M., Woods, G. M., Verter, J. I., Buchanan, G. R., Pegelow, C. H., Iyer, R. V., … Vichinsky, E. (1995). Discontinuing penicillin prophylaxis in children with sickle cell anemia. Prophylactic Penicillin Study II. J Pediatr, 127(5), 685–690. https://doi.org/10.1016/s0022-3476(95)70154-0
Falletta, J. M., G. M. Woods, J. I. Verter, G. R. Buchanan, C. H. Pegelow, R. V. Iyer, S. T. Miller, C. T. Holbrook, T. R. Kinney, and E. Vichinsky. “Discontinuing penicillin prophylaxis in children with sickle cell anemia. Prophylactic Penicillin Study II.J Pediatr 127, no. 5 (November 1995): 685–90. https://doi.org/10.1016/s0022-3476(95)70154-0.
Falletta JM, Woods GM, Verter JI, Buchanan GR, Pegelow CH, Iyer RV, et al. Discontinuing penicillin prophylaxis in children with sickle cell anemia. Prophylactic Penicillin Study II. J Pediatr. 1995 Nov;127(5):685–90.
Falletta, J. M., et al. “Discontinuing penicillin prophylaxis in children with sickle cell anemia. Prophylactic Penicillin Study II.J Pediatr, vol. 127, no. 5, Nov. 1995, pp. 685–90. Pubmed, doi:10.1016/s0022-3476(95)70154-0.
Falletta JM, Woods GM, Verter JI, Buchanan GR, Pegelow CH, Iyer RV, Miller ST, Holbrook CT, Kinney TR, Vichinsky E. Discontinuing penicillin prophylaxis in children with sickle cell anemia. Prophylactic Penicillin Study II. J Pediatr. 1995 Nov;127(5):685–690.
Journal cover image

Published In

J Pediatr

DOI

ISSN

0022-3476

Publication Date

November 1995

Volume

127

Issue

5

Start / End Page

685 / 690

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Time Factors
  • Streptococcus pneumoniae
  • Pneumococcal Infections
  • Penicillins
  • Pediatrics
  • Meningitis, Pneumococcal
  • Male
  • Humans