Compliance with intramuscular penicillin prophylaxis in children with sickle cell disease in Jamaica / Cumplimiento de las normas terapéuticas en la profilaxis con penicilina intramuscular en niños jamaicanos con anemia falciforme

OBJECTIVES: Penicillin prophylaxis is important in the defence against invasive pneumococcal disease in sickle cell disease (SCD). Penicillin may be administered by the oral route or by the intramuscular (IM) route. Compliance with the oral route, although difficult to assess, has been reported to be highly variable and often poor. We sought to determine the compliance rate with intramuscular penicillin (IM) prophylaxis in children with sickle cell disease. METHODS: Children followed at the Sickle Cell Unit in Jamaica were recruited. Good compliance was deemed if patients received at least 10 injections over the preceding 12months. Children on IM prophylaxis for less than a 12month period were deemed to be compliant if they received 80! of injections since commencing prophylaxis. RESULTS: Data were available for 78 (HB SS 73; male 42) patients attending the clinic during the period of observation. Sixtynine (88.5!) of the children were compliant with IM penicillin prophylaxis. CONCLUSIONS: This study reports a high compliance (88.5!) to IM penicillin prophylaxis which was associated with an incidence rate of invasive pneumococcal disease lower than what is seen in other comparable studies, reflecting the route of administration. Intramuscular penicillin prophylaxis, despite challenges, is a practical option. It can contribute to better patient compliance and thus significantly impact global rates of invasive pneumococcal disease and its complications in children with SCD and other similar conditions.

OBJETIVO: La profilaxis con penicilina es importante en la defensa contra la enfermedad neumocócica invasiva de la enfermedad de células falciformes (ECF). La penicilina puede administrarse por vía oral o por vía intramuscular (IM). El cumplimiento terapéutico por vía oral - aunque es difícil de evaluar-se ha reportado como altamente variable y a menudo pobre. Se buscó determinar la tasa de cumplimiento terapéutico con la profilaxis de penicilina intramuscular (IM) en niños con enfermedad de células falciformes. MÉTODOS: Se reclutaron niños bajo seguimiento en la Unidad de Células Falciformes en Jamaica. Se consideraba un buen cumplimiento el que los pacientes recibieran al menos 10 inyecciones en los últimos 12 meses. Se consideraba que los niños bajo profilaxis IM por un período menor de 12 meses habían cumplido las normas terapéuticas, siempre que hubiesen recibido el 80! de las inyecciones desde el comienzo de la profilaxis. RESULTADOS: Hubo datos disponibles para 78 (HB SS 73; 42 hombres) pacientes que asistieron a la clínica durante el período de observación. Sesenta y nueve (88,5!) de los niños cumplieron con las normas de la profilaxis con penicilina IM. CONCLUSIONES: Este estudio reporta un alto cumplimiento (88,5!) con la profilaxis de la penicilina IM, asociado con una tasa de incidencia de la enfermedad neumocócica invasiva, inferior a la que se observa en otros estudios comparables que reflejan la vía de administración. A pesar de los desafíos, la profilaxis con penicilina intramuscular, es una opción práctica. Puede contribuir a un mejor cumplimiento del paciente, y así afectar significativamente las tasas globales de la enfermedad neumocócica invasiva y sus complicaciones en niños con ECF y otras condiciones similares.

HIV serostatus and recovery from severe childhood malnutrition. A retrospective matched case-control study

The world-wide epidemic of Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) has led to an increase in the number of HIV positive children, mainly through perinatal transmission. HIV/AIDS can lead to severe childhood malnutrition (SCM) and has been noted as an increasingly common cause of secondary SCM. In this context, it is important to make assessments of the appropriateness of current approaches to treatment of severe malnutrition in HIV positive children. A retrospective matched case-control study of ten HIV positive children admitted to the Tropical Metabolism Research Unit (TMRU) was conducted. There were few differences between cases and matched controls on admission to the ward. Oral candidiasis and lower respiratory tract infections appeared to occur more frequently, and serum globulin concentrations were significantly higher among HIV positive cases when compared to their controls. Despite the fact that the differences between cases and controls appeared to be small, four cases died; there were no deaths among the controls. The duration of the maintenance phase was approximately five days longer (p = 0.024) among cases than controls but the time between the end of the maintenance phase and discharge from the ward was not significantly longer for the cases. The results of this matched case-control study suggest that there are likely to be important differences between HIV positive and negative patients with SCM that influence risk of mortality and morbidity, particularly in the maintenance phase of treatment. Prospective studies will be required in order to explore these differences and to develop better approaches to the care of HIV positive children with SCM