Influence of penicillin prophylaxis on antimicrobial resistance in nasopharyngeal S. pneumoniae among children with sickle cell anemia

Gerald M. Woods, James H. Jorgensen, Myron A. Waclawiw, Clarice Reid, Winfred Wang, Charles H. Pegelow, Zora R. Rogers, Rathi V. Iyer, C. Tate Holbrook, Thomas R. Kinney, Elliott Vichinsky, Michael R. DeBaun, Neil J. Grossman, Marilyn D. Thomas, John M. Falletta

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Purpose: To evaluate the consequences of prolonged prophylactic penicillin use on the rates of nasopharyngeal colonization with Streptococcus pneumoniae and the prevalence of resistant pneumococcal strains in children with sickle cell anemia. Methods: Nasopharyngeal specimens were obtained from children with sickle cell anemia (Hb SS or Hb Sβ(o) thalassemia) at 10 teaching hospitals throughout the United States. These patients were participating in a prospective, randomized, placebo-controlled trial in which they were prescribed prophylactic penicillin before their fifth birthday and were randomized to prophylactic penicillin or placebo after their fifth birthday (PROPS II). The specimens were cultured for S. pneumoniae, and isolates were analyzed for antimicrobial susceptibility to nine commonly prescribed antimicrobial agents. Results: Of the 226 patients observed, an average of 8.4 specimens were collected per patient. From 1,896 individual culture specimens, 5.5% of the specimens were positive for S. pneumoniae; 27% of patients had at least one positive culture. Nine percent of the study patients had at least one isolate of penicillin intermediate or resistant pneumococci. There was no significant difference in the percent of positive cultures for S. pneumoniae in those patients given penicillin prophylaxis after 5 years of age (4.1%) compared with those patients given placebo after 5 years of age (6.4%). Likewise, there was no significant difference (p = 0.298) in the percent of patients with at least one positive culture for S. pneumoniae in the group given prophylactic penicillin after 5 years of age (21.8%) compared with the group given placebo after 5 years of age (28.3%). There was no difference between the penicillin and placebo groups in the proportion of patients with penicillin intermediate or resistant pneumococci, but there was a trend toward increased carriage of multiply drug-resistant pneumococci in children > 5 years of age receiving prophylactic penicillin compared to children > 5 years of age receiving placebo. The increased colonization rate with multiply drag-resistant organisms of children > 5 years of age receiving penicillin prophylaxis is not statistically significant. Conclusions: The potential for continued penicillin prophylaxis to contribute to the development of multiply resistant pneumococci should be considered before continuing penicillin prophylaxis in children with sickle cell anemia who are older than 5 years of age. Added to the published data from PROPS II, which demonstrated no apparent advantage to continue prophylaxis, the data support the conclusion that, for children with no history of invasive pneumococcal disease, consideration should be given to discontinue prophylactic penicillin after their fifth birthday.

Original languageEnglish (US)
Pages (from-to)327-333
Number of pages7
JournalJournal of Pediatric Hematology/Oncology
Volume19
Issue number4
DOIs
StatePublished - Jul 1997

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Sickle Cell Anemia
Penicillins
Pneumonia
Streptococcus pneumoniae
Placebos
Thalassemia
Anti-Infective Agents
Teaching Hospitals
Randomized Controlled Trials

Keywords

  • Penicillin prophylaxis
  • Resistant pneumococci
  • Sickle cell anemia

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Oncology
  • Hematology

Cite this

Influence of penicillin prophylaxis on antimicrobial resistance in nasopharyngeal S. pneumoniae among children with sickle cell anemia. / Woods, Gerald M.; Jorgensen, James H.; Waclawiw, Myron A.; Reid, Clarice; Wang, Winfred; Pegelow, Charles H.; Rogers, Zora R.; Iyer, Rathi V.; Tate Holbrook, C.; Kinney, Thomas R.; Vichinsky, Elliott; DeBaun, Michael R.; Grossman, Neil J.; Thomas, Marilyn D.; Falletta, John M.

In: Journal of Pediatric Hematology/Oncology, Vol. 19, No. 4, 07.1997, p. 327-333.

Research output: Contribution to journalArticle

Woods, GM, Jorgensen, JH, Waclawiw, MA, Reid, C, Wang, W, Pegelow, CH, Rogers, ZR, Iyer, RV, Tate Holbrook, C, Kinney, TR, Vichinsky, E, DeBaun, MR, Grossman, NJ, Thomas, MD & Falletta, JM 1997, 'Influence of penicillin prophylaxis on antimicrobial resistance in nasopharyngeal S. pneumoniae among children with sickle cell anemia', Journal of Pediatric Hematology/Oncology, vol. 19, no. 4, pp. 327-333. https://doi.org/10.1097/00043426-199707000-00011
Woods, Gerald M. ; Jorgensen, James H. ; Waclawiw, Myron A. ; Reid, Clarice ; Wang, Winfred ; Pegelow, Charles H. ; Rogers, Zora R. ; Iyer, Rathi V. ; Tate Holbrook, C. ; Kinney, Thomas R. ; Vichinsky, Elliott ; DeBaun, Michael R. ; Grossman, Neil J. ; Thomas, Marilyn D. ; Falletta, John M. / Influence of penicillin prophylaxis on antimicrobial resistance in nasopharyngeal S. pneumoniae among children with sickle cell anemia. In: Journal of Pediatric Hematology/Oncology. 1997 ; Vol. 19, No. 4. pp. 327-333.
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abstract = "Purpose: To evaluate the consequences of prolonged prophylactic penicillin use on the rates of nasopharyngeal colonization with Streptococcus pneumoniae and the prevalence of resistant pneumococcal strains in children with sickle cell anemia. Methods: Nasopharyngeal specimens were obtained from children with sickle cell anemia (Hb SS or Hb Sβ(o) thalassemia) at 10 teaching hospitals throughout the United States. These patients were participating in a prospective, randomized, placebo-controlled trial in which they were prescribed prophylactic penicillin before their fifth birthday and were randomized to prophylactic penicillin or placebo after their fifth birthday (PROPS II). The specimens were cultured for S. pneumoniae, and isolates were analyzed for antimicrobial susceptibility to nine commonly prescribed antimicrobial agents. Results: Of the 226 patients observed, an average of 8.4 specimens were collected per patient. From 1,896 individual culture specimens, 5.5{\%} of the specimens were positive for S. pneumoniae; 27{\%} of patients had at least one positive culture. Nine percent of the study patients had at least one isolate of penicillin intermediate or resistant pneumococci. There was no significant difference in the percent of positive cultures for S. pneumoniae in those patients given penicillin prophylaxis after 5 years of age (4.1{\%}) compared with those patients given placebo after 5 years of age (6.4{\%}). Likewise, there was no significant difference (p = 0.298) in the percent of patients with at least one positive culture for S. pneumoniae in the group given prophylactic penicillin after 5 years of age (21.8{\%}) compared with the group given placebo after 5 years of age (28.3{\%}). There was no difference between the penicillin and placebo groups in the proportion of patients with penicillin intermediate or resistant pneumococci, but there was a trend toward increased carriage of multiply drug-resistant pneumococci in children > 5 years of age receiving prophylactic penicillin compared to children > 5 years of age receiving placebo. The increased colonization rate with multiply drag-resistant organisms of children > 5 years of age receiving penicillin prophylaxis is not statistically significant. Conclusions: The potential for continued penicillin prophylaxis to contribute to the development of multiply resistant pneumococci should be considered before continuing penicillin prophylaxis in children with sickle cell anemia who are older than 5 years of age. Added to the published data from PROPS II, which demonstrated no apparent advantage to continue prophylaxis, the data support the conclusion that, for children with no history of invasive pneumococcal disease, consideration should be given to discontinue prophylactic penicillin after their fifth birthday.",
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T1 - Influence of penicillin prophylaxis on antimicrobial resistance in nasopharyngeal S. pneumoniae among children with sickle cell anemia

AU - Woods, Gerald M.

AU - Jorgensen, James H.

AU - Waclawiw, Myron A.

AU - Reid, Clarice

AU - Wang, Winfred

AU - Pegelow, Charles H.

AU - Rogers, Zora R.

AU - Iyer, Rathi V.

AU - Tate Holbrook, C.

AU - Kinney, Thomas R.

AU - Vichinsky, Elliott

AU - DeBaun, Michael R.

AU - Grossman, Neil J.

AU - Thomas, Marilyn D.

AU - Falletta, John M.

PY - 1997/7

Y1 - 1997/7

N2 - Purpose: To evaluate the consequences of prolonged prophylactic penicillin use on the rates of nasopharyngeal colonization with Streptococcus pneumoniae and the prevalence of resistant pneumococcal strains in children with sickle cell anemia. Methods: Nasopharyngeal specimens were obtained from children with sickle cell anemia (Hb SS or Hb Sβ(o) thalassemia) at 10 teaching hospitals throughout the United States. These patients were participating in a prospective, randomized, placebo-controlled trial in which they were prescribed prophylactic penicillin before their fifth birthday and were randomized to prophylactic penicillin or placebo after their fifth birthday (PROPS II). The specimens were cultured for S. pneumoniae, and isolates were analyzed for antimicrobial susceptibility to nine commonly prescribed antimicrobial agents. Results: Of the 226 patients observed, an average of 8.4 specimens were collected per patient. From 1,896 individual culture specimens, 5.5% of the specimens were positive for S. pneumoniae; 27% of patients had at least one positive culture. Nine percent of the study patients had at least one isolate of penicillin intermediate or resistant pneumococci. There was no significant difference in the percent of positive cultures for S. pneumoniae in those patients given penicillin prophylaxis after 5 years of age (4.1%) compared with those patients given placebo after 5 years of age (6.4%). Likewise, there was no significant difference (p = 0.298) in the percent of patients with at least one positive culture for S. pneumoniae in the group given prophylactic penicillin after 5 years of age (21.8%) compared with the group given placebo after 5 years of age (28.3%). There was no difference between the penicillin and placebo groups in the proportion of patients with penicillin intermediate or resistant pneumococci, but there was a trend toward increased carriage of multiply drug-resistant pneumococci in children > 5 years of age receiving prophylactic penicillin compared to children > 5 years of age receiving placebo. The increased colonization rate with multiply drag-resistant organisms of children > 5 years of age receiving penicillin prophylaxis is not statistically significant. Conclusions: The potential for continued penicillin prophylaxis to contribute to the development of multiply resistant pneumococci should be considered before continuing penicillin prophylaxis in children with sickle cell anemia who are older than 5 years of age. Added to the published data from PROPS II, which demonstrated no apparent advantage to continue prophylaxis, the data support the conclusion that, for children with no history of invasive pneumococcal disease, consideration should be given to discontinue prophylactic penicillin after their fifth birthday.

AB - Purpose: To evaluate the consequences of prolonged prophylactic penicillin use on the rates of nasopharyngeal colonization with Streptococcus pneumoniae and the prevalence of resistant pneumococcal strains in children with sickle cell anemia. Methods: Nasopharyngeal specimens were obtained from children with sickle cell anemia (Hb SS or Hb Sβ(o) thalassemia) at 10 teaching hospitals throughout the United States. These patients were participating in a prospective, randomized, placebo-controlled trial in which they were prescribed prophylactic penicillin before their fifth birthday and were randomized to prophylactic penicillin or placebo after their fifth birthday (PROPS II). The specimens were cultured for S. pneumoniae, and isolates were analyzed for antimicrobial susceptibility to nine commonly prescribed antimicrobial agents. Results: Of the 226 patients observed, an average of 8.4 specimens were collected per patient. From 1,896 individual culture specimens, 5.5% of the specimens were positive for S. pneumoniae; 27% of patients had at least one positive culture. Nine percent of the study patients had at least one isolate of penicillin intermediate or resistant pneumococci. There was no significant difference in the percent of positive cultures for S. pneumoniae in those patients given penicillin prophylaxis after 5 years of age (4.1%) compared with those patients given placebo after 5 years of age (6.4%). Likewise, there was no significant difference (p = 0.298) in the percent of patients with at least one positive culture for S. pneumoniae in the group given prophylactic penicillin after 5 years of age (21.8%) compared with the group given placebo after 5 years of age (28.3%). There was no difference between the penicillin and placebo groups in the proportion of patients with penicillin intermediate or resistant pneumococci, but there was a trend toward increased carriage of multiply drug-resistant pneumococci in children > 5 years of age receiving prophylactic penicillin compared to children > 5 years of age receiving placebo. The increased colonization rate with multiply drag-resistant organisms of children > 5 years of age receiving penicillin prophylaxis is not statistically significant. Conclusions: The potential for continued penicillin prophylaxis to contribute to the development of multiply resistant pneumococci should be considered before continuing penicillin prophylaxis in children with sickle cell anemia who are older than 5 years of age. Added to the published data from PROPS II, which demonstrated no apparent advantage to continue prophylaxis, the data support the conclusion that, for children with no history of invasive pneumococcal disease, consideration should be given to discontinue prophylactic penicillin after their fifth birthday.

KW - Penicillin prophylaxis

KW - Resistant pneumococci

KW - Sickle cell anemia

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