Wong W Y
Division of Hematology/Oncology, Childrens Hospital Los Angeles, Los Angeles, California 90027, USA.
Paediatr Drugs. 2001;3(11):793-801. doi: 10.2165/00128072-200103110-00002.
Sickle cell anaemia (SCA) predisposes a child to infections for various reasons, including increased bone marrow turnover, poor perfusion and functional asplenia leading to decreased opsonisation of polysaccharide encapsulated organisms. Bacteria and viruses that most frequently cause serious infections in children with sickle cell disease are Streptococcus pneumoniae, Haemophilus influenzae type b, Salmonella spp., Escherichia coli, Staphylococcus aureus, Mycoplasma pneumoniae, Chlamydia pneumoniae, parvovirus B19 and hepatitis A, B and C viruses. Penicillin prophylaxis has decreased the incidence of infection-related morbidity and mortality significantly in children with SCA. Children <3 years of age are administered oral penicillin 125mg twice daily, and the dose is increased to 250mg twice daily for the >3 to 5 year age group. Adherence to the penicillin prophylactic regimen is recommended for children with SCA who are >5 years of age. For children with SCA who have recurrent invasive pneumococcal infections, an effort is made to keep the child on penicillin prophylaxis indefinitely. The administration of various childhood vaccines has also made an appreciable impact on the overall morbidity and mortality associated with infection in children with SCA. The administration of the heptavalent conjugate pneumococcal vaccine (PCV7) has provided control of invasive pneumococcal infections, and the prophylactic use of the H. influenzae type b conjugate vaccine has reduced the incidence of septicaemia and meningitis caused by this organism. Other vaccines used prophylactically in children with SCA include hepatitis A and B, and vaccines against influenza and varicella viruses. The immediate administration of intravenous antibacterials, after appropriate blood and urine cultures, is of great importance in the treatment of the febrile child with SCA. Ceftriaxone and cefotaxime have been recommended for the treatment of septic episodes in SCA associated with S. pneumoniae, Haemophilus and Salmonella spp. Infection with Yersinia enterocolitica may be treated with cefotaxime or an aminoglycoside. The prevalence of Helicobacter pylori infection in SCA is unknown. Effective therapies include metronidazole, tetracycline or amoxicillin. Parvovirus infections require supportive care and specific antiviral therapy is not indicated. The judicious use of antimicrobials is encouraged in view of the worldwide emergence of multidrug-resistant strains. The long term sequelae associated with infections in children with SCA can be decreased with the implementation of immunisation programmes and effective and prompt treatment with appropriate antibacterials.
镰状细胞贫血（SCA）使儿童因多种原因易发生感染，包括骨髓周转率增加、灌注不良和功能性无脾，导致多糖包膜菌的调理作用降低。在镰状细胞病患儿中最常引起严重感染的细菌和病毒有肺炎链球菌、b型流感嗜血杆菌、沙门氏菌属、大肠杆菌、金黄色葡萄球菌、肺炎支原体、肺炎衣原体、细小病毒B19以及甲型、乙型和丙型肝炎病毒。青霉素预防性用药已显著降低了SCA患儿感染相关的发病率和死亡率。3岁以下儿童每日口服青霉素125mg，分两次服用，3至5岁年龄组剂量增至每日250mg，分两次服用。建议5岁以上的SCA患儿坚持青霉素预防方案。对于有复发性侵袭性肺炎球菌感染的SCA患儿，应努力让其长期接受青霉素预防性用药。各种儿童疫苗的接种也对SCA患儿感染相关的总体发病率和死亡率产生了显著影响。七价结合肺炎球菌疫苗（PCV7）的接种已控制了侵袭性肺炎球菌感染，b型流感嗜血杆菌结合疫苗的预防性使用降低了该菌引起的败血症和脑膜炎的发病率。SCA患儿预防性使用的其他疫苗包括甲型和乙型肝炎疫苗以及流感和水痘病毒疫苗。在对发热的SCA患儿进行治疗时，在进行适当的血液和尿液培养后立即给予静脉抗菌药物非常重要。头孢曲松和头孢噻肟被推荐用于治疗与肺炎链球菌、流感嗜血杆菌和沙门氏菌属相关的SCA败血症发作。小肠结肠炎耶尔森菌感染可用头孢噻肟或氨基糖苷类药物治疗。SCA中幽门螺杆菌感染的患病率尚不清楚。有效的治疗方法包括甲硝唑、四环素或阿莫西林。细小病毒感染需要支持治疗，不建议使用特定的抗病毒治疗。鉴于全球多药耐药菌株的出现，鼓励明智地使用抗菌药物。通过实施免疫计划以及使用适当的抗菌药物进行有效和及时的治疗，可以降低SCA患儿感染相关的长期后遗症。
