Prophylactic penicillin after 5 years of age in patients with sickle cell disease: A survey of sickle cell disease experts

Background: Since the publication of the Prophlyactic Penicillin Study II in 1995, the management of penicillin prophylaxis for children with sickle cell disease (SCD) after 5 years of age has been controversial. In this study, we sought to describe current practice patterns of pediatric hematologists related to cessation of penicillin prophylaxis for children with SCD after 5 years of age. Procedure: We performed a cross-sectional, electronic survey of pediatric hematologists with expertise in SCD to examine practices regarding penicillin prophylaxis in children with SCD after 5 years of age. We also investigated factors potentially associated with continuation of penicillin prophylaxis using the Jonckheere-Terpstra test and Fisher's exact test. Results: Of the 106 physicians surveyed from 76 centers, 84% completed the survey. Among respondents, 76% routinely recommended cessation of penicillin prophylaxis after 5 years of age. The practice of routinely continuing penicillin after 5 years of age was associated with decreased concern about antibiotic resistance in Streptococcus pneumoniae (P=0.01), with the usage of prophylactic penicillin in mild SCD genotypes (sickle hemoglobin-C disease and sickle β⁺ thalassemia, P=<0.001), and with increasing use of other preventive evaluations (e.g., MRI for silent stroke) in childhood (P=0.05). Conclusion: Most pediatric hematologists with an SCD expertise recommend cessation of prophylactic penicillin after 5 years of age.