Bitarães Enio Latini, Oliveira Benigna Maria de, Viana Marcos Borato
Fundação Mineira de Educação e Cultura - Faculdade de Ciências da Saúde (FUMEC-FCS), Belo Horizonte, MG, Brazil.
J Pediatr (Rio J). 2008 Jul-Aug;84(4):316-22. doi: 10.2223/JPED.1819.
To prospectively assess compliance with antibiotic prophylaxis among children with sickle cell anemia.
A total of 108 children (aged 3 months to 4(1/2) years, 45% male) were recruited from the Hematology Center in Belo Horizonte, Brazil, and followed up for 15 months. Data on compliance were obtained from three interviews with the primary caregivers, from the children's medical records and from assay of antibacterial activity in urine samples of 81 children. Antibiotics were available free of charge.
Penicillin was used in 106 cases (majority by oral route); erythromycin in 2 cases. Urine samples tested positive for the antibiotic in 56% of the cases; 48% of the caregivers assured during interviews that all doses had been administered to children; 89% of medical files recorded no compliance failures. Considering a child compliant if none or just one of these methods detected missing doses, the rate of compliance was 67%. The agreement between methods for assigning a child as compliant or not was low. No significant association of compliance rate with gender, nutritional status, per capita income of the family, caregivers' schooling, or number of family members was demonstrated.
Compliance rate with prophylactic antibiotic therapy was low when assessed by interviews and urine tests and overestimated by analysis of medical records. Compliance should preferably be assessed by several methods due to the complex character of its measurement. The results of the present study suggest the need for a comprehensive educational program involving healthcare professionals, families and children with sickle cell anemia.
前瞻性评估镰状细胞贫血患儿抗生素预防治疗的依从性。
从巴西贝洛奥里藏特的血液学中心招募了108名儿童（年龄3个月至4.5岁，45%为男性），并进行了15个月的随访。依从性数据来自对主要照顾者的三次访谈、儿童病历以及对81名儿童尿液样本抗菌活性的检测。抗生素免费提供。
106例使用青霉素（多数为口服途径）；2例使用红霉素。56%的病例尿液样本抗生素检测呈阳性；48%的照顾者在访谈中保证已给儿童服用所有剂量；89%的医疗档案记录无依从性失败情况。若这些方法中无或仅一种检测到漏服剂量则判定儿童依从，依从率为67%。判定儿童是否依从的方法之间一致性较低。未发现依从率与性别、营养状况、家庭人均收入、照顾者受教育程度或家庭成员数量有显著关联。
通过访谈和尿液检测评估时，预防性抗生素治疗的依从率较低，而通过病历分析则高估了依从率。由于依从性测量的复杂性，最好通过多种方法进行评估。本研究结果表明需要开展一项涉及医疗保健专业人员、家庭和镰状细胞贫血患儿的综合教育项目。
