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Prophylactic antibiotics for preventing pneumococcal infection in children with sickle cell disease.
Rankine-Mullings, Angela E; Owusu-Ofori, Shirley.
  • Rankine-Mullings AE; Sickle Cell Unit, Caribbean Institute for Health Research, University of the West Indies, Kingston, Jamaica.
  • Owusu-Ofori S; Transfusion Medicine Unit, Komfo Anokye Teaching Hospital, Kumasi, Ghana.
Cochrane Database Syst Rev ; 3: CD003427, 2021 03 08.
Article in English | MEDLINE | ID: covidwho-1135064
Semantic information from SemMedBD (by NLM)
1. Anemi PROCESS_OF C0008059
Subject
Anemi
Predicate
PROCESS_OF
Object
C0008059
2. Pneumococcal Infections PROCESS_OF Child
Subject
Pneumococcal Infections
Predicate
PROCESS_OF
Object
Child
3. Anemi PROCESS_OF C0027361
Subject
Anemi
Predicate
PROCESS_OF
Object
C0027361
4. pneumococcal sepsis PROCESS_OF Child
Subject
pneumococcal sepsis
Predicate
PROCESS_OF
Object
Child
5. limited use TREATS Age Cohort
Subject
limited use
Predicate
TREATS
Object
Age Cohort
6. Treatment Protocols USES penicillins
Subject
Treatment Protocols
Predicate
USES
Object
penicillins
7. Antibiotic Prophylaxis TREATS Anemi
Subject
Antibiotic Prophylaxis
Predicate
TREATS
Object
Anemi
8. Antibiotic Prophylaxis TREATS Child
Subject
Antibiotic Prophylaxis
Predicate
TREATS
Object
Child
9. Problem COEXISTS_WITH COVID-19
Subject
Problem
Predicate
COEXISTS_WITH
Object
COVID-19
10. penicillins PREDISPOSES Pneumococcal Infections
Subject
penicillins
Predicate
PREDISPOSES
Object
Pneumococcal Infections
11. penicillins PREVENTS Pneumococcal Infections
Subject
penicillins
Predicate
PREVENTS
Object
Pneumococcal Infections
12. Anemia, Sickle Cell PROCESS_OF Child
Subject
Anemia, Sickle Cell
Predicate
PROCESS_OF
Object
Child
13. Pneumococcal Infections PROCESS_OF Child
Subject
Pneumococcal Infections
Predicate
PROCESS_OF
Object
Child
14. Anemia, Sickle Cell PROCESS_OF Persons
Subject
Anemia, Sickle Cell
Predicate
PROCESS_OF
Object
Persons
15. pneumococcal sepsis PROCESS_OF Child
Subject
pneumococcal sepsis
Predicate
PROCESS_OF
Object
Child
16. limited use TREATS Age Cohort
Subject
limited use
Predicate
TREATS
Object
Age Cohort
17. Treatment Protocols USES penicillins
Subject
Treatment Protocols
Predicate
USES
Object
penicillins
18. Antibiotic Prophylaxis TREATS Anemia, Sickle Cell
Subject
Antibiotic Prophylaxis
Predicate
TREATS
Object
Anemia, Sickle Cell
19. Antibiotic Prophylaxis TREATS Child
Subject
Antibiotic Prophylaxis
Predicate
TREATS
Object
Child
20. Problem COEXISTS_WITH COVID-19
Subject
Problem
Predicate
COEXISTS_WITH
Object
COVID-19
21. penicillins PREDISPOSES Pneumococcal Infections
Subject
penicillins
Predicate
PREDISPOSES
Object
Pneumococcal Infections
22. penicillins PREVENTS Pneumococcal Infections
Subject
penicillins
Predicate
PREVENTS
Object
Pneumococcal Infections
ABSTRACT

BACKGROUND:

Sickle cell disease (SCD) is a group of inherited disorders that result in haemoglobin abnormalities and other complications. Injury to the spleen, among other factors, contribute to persons with SCD being particularly susceptible to infection. Infants and very young children are especially vulnerable. The 'Co-operative Study of Sickle Cell Disease' observed an incidence rate for pneumococcal septicaemia of 10 per 100 person-years in children under the age of three years. Vaccines, including customary pneumococcal vaccines, may be of limited use in this age group. Therefore, prophylactic penicillin regimens may be advisable for this population. This is an update of a Cochrane Review which was first published in 2002, and previously updated, most recently in 2017. 

OBJECTIVES:

To compare the effects of antibiotic prophylaxis against pneumococcus in children with SCD receiving antibiotic prophylaxis compared to those without in relation to 1. incidence of Streptococcus pneumoniae infection; 2. mortality (as reported in the included studies); 3. drug-related adverse events (as reported in the included studies) to the individual and the community; 4. the impact of discontinuing at various ages on incidence of infection and mortality. SEARCH

METHODS:

We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Haemoglobinopathies Trials Register, which is comprised of references identified from comprehensive electronic database searches and also two clinical trials registries ClinicalTrials.gov and the WHO International Registry Platform (not in 2020 given access issues relating to Covid-19 pandemic). Additionally, we carried out hand searching of relevant journals and abstract books of conference proceedings. Date of the most recent search 25 January 2021. SELECTION CRITERIA All randomised or quasi-randomised controlled trials comparing prophylactic antibiotics to prevent pneumococcal infection in children with SCD with placebo, no treatment or a comparator drug. DATA COLLECTION AND

ANALYSIS:

The standard methodological procedures expected by Cochrane were used. Both authors independently extracted data and assessed trial quality. The authors used the GRADE criteria to assess the certainty of the evidence. MAIN

RESULTS:

Six trials were identified by the searches, of which three trials were eligible for inclusion. A total of 880 childrenwho were between three months to five years of age at randomization were included. The included studies were conducted in centres in the USA and in Kingston, Jamaica. In trials that investigated initiation of penicillin on risk of pneumococcal infection, the odds ratio was 0.37 (95% confidence interval 0.16 to 0.86) (two trials, 457 children) (low-certainty evidence), while for withdrawal the odds ratio was 0.49 (95% confidence interval 0.09 to 2.71) (one trial, 400 children) (low-certainty evidence). Adverse drug effects were rare and minor. Rates of pneumococcal infection were found to be relatively low in children over the age of five years. Overall, the certainty of the evidence for all outcomes was judged to be low. The results from the risk of bias assessment undertaken identified two domains in which the risk of bias was considered to be high, these were incomplete outcome data (attrition bias) (two trials) and allocation concealment (selection bias) (one trial). Domains considered to have a low risk of bias for all three trials were selective reporting (reporting bias) and blinding (performance and detection bias). AUTHORS'

CONCLUSIONS:

The evidence examined was determined to be of low certainty and suggests that prophylactic penicillin significantly reduces risk of pneumococcal infection in children with homozygous SCD, and is associated with minimal adverse reactions. Further research may help to determine the ideal age to safely withdraw penicillin.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Penicillins / Pneumococcal Infections / Antibiotic Prophylaxis / Anemia, Sickle Cell Type of study: Experimental Studies / Observational study / Prognostic study / Randomized controlled trials / Reviews / Systematic review/Meta Analysis Topics: Long Covid / Vaccines Limits: Child, preschool / Humans / Infant Language: English Journal: Cochrane Database Syst Rev Journal subject: Health Services Research Year: 2021 Document Type: Article Affiliation country: 14651858.CD003427.pub5

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Penicillins / Pneumococcal Infections / Antibiotic Prophylaxis / Anemia, Sickle Cell Type of study: Experimental Studies / Observational study / Prognostic study / Randomized controlled trials / Reviews / Systematic review/Meta Analysis Topics: Long Covid / Vaccines Limits: Child, preschool / Humans / Infant Language: English Journal: Cochrane Database Syst Rev Journal subject: Health Services Research Year: 2021 Document Type: Article Affiliation country: 14651858.CD003427.pub5