Discontinuing penicillin prophylaxis in children with sickle cell anemia

John M. Falletta, Gerald M. Woods, Joel I. Verter, George R. Buchanan, Charles H. Pegelow, Rathi V. Iyer, Scott T. Miller, C. Tate Holbrook, Thomas R. Kinney, Elliott Vichinsky, David L. Becton, Winfred Wang, Helen S. Johnstone, Doris L. Wethers, Gregory H. Reaman, Michael R. DeBaun, Neil J. Grossman, Karen Kalinyak, James H. Jorgensen, Ann BjornsonMarilyn D. Thomas, Clarice Reid

Research output: Contribution to journalArticle

151 Citations (Scopus)

Abstract

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 β0-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. (J PEDIATR 1995;127:685-90).

Original languageEnglish (US)
Pages (from-to)685-690
Number of pages6
JournalThe Journal of Pediatrics
Volume127
Issue number5
DOIs
StatePublished - 1995

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Sickle Cell Anemia
Penicillins
Placebos
Sickle Hemoglobin
Pneumococcal Infections
Confidence Intervals
Random Allocation
Penicillin V
Pneumococcal Meningitis
Pneumococcal Vaccines
Thalassemia
Splenectomy
Bacteremia
Teaching Hospitals
Pharmaceutical Preparations
Nausea
Tablets
Physical Examination
Vomiting
Fever

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Falletta, J. M., Woods, G. M., Verter, J. I., Buchanan, G. R., Pegelow, C. H., Iyer, R. V., ... Reid, C. (1995). Discontinuing penicillin prophylaxis in children with sickle cell anemia. The Journal of Pediatrics, 127(5), 685-690. https://doi.org/10.1016/S0022-3476(95)70154-0

Discontinuing penicillin prophylaxis in children with sickle cell anemia. / Falletta, John M.; Woods, Gerald M.; Verter, Joel I.; Buchanan, George R.; Pegelow, Charles H.; Iyer, Rathi V.; Miller, Scott T.; Holbrook, C. Tate; Kinney, Thomas R.; Vichinsky, Elliott; Becton, David L.; Wang, Winfred; Johnstone, Helen S.; Wethers, Doris L.; Reaman, Gregory H.; DeBaun, Michael R.; Grossman, Neil J.; Kalinyak, Karen; Jorgensen, James H.; Bjornson, Ann; Thomas, Marilyn D.; Reid, Clarice.

In: The Journal of Pediatrics, Vol. 127, No. 5, 1995, p. 685-690.

Research output: Contribution to journalArticle

Falletta, JM, Woods, GM, Verter, JI, Buchanan, GR, Pegelow, CH, Iyer, RV, Miller, ST, Holbrook, CT, Kinney, TR, Vichinsky, E, Becton, DL, Wang, W, Johnstone, HS, Wethers, DL, Reaman, GH, DeBaun, MR, Grossman, NJ, Kalinyak, K, Jorgensen, JH, Bjornson, A, Thomas, MD & Reid, C 1995, 'Discontinuing penicillin prophylaxis in children with sickle cell anemia', The Journal of Pediatrics, vol. 127, no. 5, pp. 685-690. https://doi.org/10.1016/S0022-3476(95)70154-0
Falletta, John M. ; Woods, Gerald M. ; Verter, Joel I. ; Buchanan, George R. ; Pegelow, Charles H. ; Iyer, Rathi V. ; Miller, Scott T. ; Holbrook, C. Tate ; Kinney, Thomas R. ; Vichinsky, Elliott ; Becton, David L. ; Wang, Winfred ; Johnstone, Helen S. ; Wethers, Doris L. ; Reaman, Gregory H. ; DeBaun, Michael R. ; Grossman, Neil J. ; Kalinyak, Karen ; Jorgensen, James H. ; Bjornson, Ann ; Thomas, Marilyn D. ; Reid, Clarice. / Discontinuing penicillin prophylaxis in children with sickle cell anemia. In: The Journal of Pediatrics. 1995 ; Vol. 127, No. 5. pp. 685-690.
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author = "Falletta, {John M.} and Woods, {Gerald M.} and Verter, {Joel I.} and Buchanan, {George R.} and Pegelow, {Charles H.} and Iyer, {Rathi V.} and Miller, {Scott T.} and Holbrook, {C. Tate} and Kinney, {Thomas R.} and Elliott Vichinsky and Becton, {David L.} and Winfred Wang and Johnstone, {Helen S.} and Wethers, {Doris L.} and Reaman, {Gregory H.} and DeBaun, {Michael R.} and Grossman, {Neil J.} and Karen Kalinyak and Jorgensen, {James H.} and Ann Bjornson and Thomas, {Marilyn D.} and Clarice Reid",
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T1 - Discontinuing penicillin prophylaxis in children with sickle cell anemia

AU - Falletta, John M.

AU - Woods, Gerald M.

AU - Verter, Joel I.

AU - Buchanan, George R.

AU - Pegelow, Charles H.

AU - Iyer, Rathi V.

AU - Miller, Scott T.

AU - Holbrook, C. Tate

AU - Kinney, Thomas R.

AU - Vichinsky, Elliott

AU - Becton, David L.

AU - Wang, Winfred

AU - Johnstone, Helen S.

AU - Wethers, Doris L.

AU - Reaman, Gregory H.

AU - DeBaun, Michael R.

AU - Grossman, Neil J.

AU - Kalinyak, Karen

AU - Jorgensen, James H.

AU - Bjornson, Ann

AU - Thomas, Marilyn D.

AU - Reid, Clarice

PY - 1995

Y1 - 1995

N2 - 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 β0-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. (J PEDIATR 1995;127:685-90).

AB - 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 β0-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. (J PEDIATR 1995;127:685-90).

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