Antibiotic Prophylaxis for Children With Sickle Cell Anemia

Abstract

Background: Children with sickle cell anemia (SCA) are at increased risk for invasive pneumococcal disease; antibiotic prophylaxis significantly reduces this risk. We calculated the proportion of children with SCA who received ≥300 days of antibiotic prophylaxis and identified predictors of such receipt.

Methods: Children aged 3 months to 5 years with SCA were identified by the presence of 3 or more Medicaid claims with a diagnosis of SCA within a calendar year (2005-2012) in Florida, Illinois, Louisiana, Michigan, South Carolina, and Texas. Receipt of antibiotics was identified through claims for filled prescriptions. The outcome, receipt of ≥300 days of antibiotics, was assessed annually by using varying classifications of antibiotics. By using logistic regression with generalized estimating equations, we estimated the odds of receiving ≥300 days of antibiotics, with potential predictors of age, sex, year, state, and health services use.

Results: A total of 2821 children contributed 5014 person-years. Overall, only 18% of children received ≥300 days of antibiotics. Each additional sickle cell disease-related outpatient visit (odds ratio = 1.01, 95% confidence interval: 1.01-1.02) and well-child visit (odds ratio = 1.08, 95% confidence interval: 1.02-1.13) was associated with incrementally increased odds of receiving ≥300 days of antibiotics.

Conclusions: Despite national recommendations and proven lifesaving benefit, antibiotic prophylaxis rates are low among children with SCA. Numerous health care encounters may offer an opportunity for intervention; in addition, such interventions likely need to include social factors that may affect the ability for a child to receive and adhere to antibiotic prophylaxis.

Figure 1.

A, Mean number of days of dispensed antibiotics per child with SCA, by definition and year. B, Proportion of children with SCA dispensed ≥300 days of antibiotics within a year, by definition and year.

Figure 1.

A, Mean number of days of dispensed antibiotics per child with SCA, by definition and year. B, Proportion of children with SCA dispensed ≥300 days of antibiotics within a year, by definition and year.

Figure 2.

Proportion of children with SCA with ≥300 days of filled antibiotics within a year. Antibiotics are defined as penicillin, erythromycin, or amoxicillin.