An audit of the vaccination and antibiotic prophylaxis practices amongst patients splenectomised in Lothian.

OBJECTIVE

To evaluate current post-splenectomy immunisation and antibiotic prophylaxis practices amongst patients splenectomised in Lothian between 1st January 1989 and 31st December 1997.

DESIGN

Retrospective cross-sectional study of the general practitioners of patients recorded as having had a splenectomy operation.

SETTING

Lothian Health Board (population 771,000).

SUBJECTS

Asplenic patients recorded on Scottish Morbidity Records as having had a splenectomy in Lothian between 1st January 1989 and 31st December 1997.

RESULTS

Eighty point six percent of the patients were vaccinated against Streptococcus pneumoniae, 65.9% were vaccinated against Haemophilus influenzae, and 48.2% were vaccinated against Neisseria meningitidis; 74.8% of patients were being prescribed long-term antibiotic prophylaxis. However, only 37.4% were both vaccinated and prescribed prophylaxis as recommended, in Department of Health guidelines.

CONCLUSIONS

The vaccination levels seen in this survey are higher than levels reported in previously published surveys in the UK. Reported rates of post splenectomy vaccination against S. pneumoniae in both the UK and North America in 1993 ranged from 10% to 36%. However, there still remains a substantial proportion of splenectomised patients in Lothian, including some of those with the highest risk of infection, who are not vaccinated or prescribed prophylaxis as recommended.