Division of Hematology-Oncology, University of Texas Southwestern Medical Center, Dallas, TX 75390-9063, USA.
Pediatr Blood Cancer. 2013 Jun;60(6):935-9. doi: 10.1002/pbc.24395. Epub 2012 Nov 28.
Since the publication of the Prophlyactic Penicillin Study II in 1995, the management of penicillin prophylaxis for children with sickle cell disease (SCD) after 5 years of age has been controversial. In this study, we sought to describe current practice patterns of pediatric hematologists related to cessation of penicillin prophylaxis for children with SCD after 5 years of age.
We performed a cross-sectional, electronic survey of pediatric hematologists with expertise in SCD to examine practices regarding penicillin prophylaxis in children with SCD after 5 years of age. We also investigated factors potentially associated with continuation of penicillin prophylaxis using the Jonckheere-Terpstra test and Fisher's exact test.
Of the 106 physicians surveyed from 76 centers, 84% completed the survey. Among respondents, 76% routinely recommended cessation of penicillin prophylaxis after 5 years of age. The practice of routinely continuing penicillin after 5 years of age was associated with decreased concern about antibiotic resistance in Streptococcus pneumoniae (P = 0.01), with the usage of prophylactic penicillin in mild SCD genotypes (sickle hemoglobin-C disease and sickle β(+) thalassemia, P = <0.001), and with increasing use of other preventive evaluations (e.g., MRI for silent stroke) in childhood (P = 0.05).
Most pediatric hematologists with an SCD expertise recommend cessation of prophylactic penicillin after 5 years of age.
自 1995 年《预防性青霉素研究 II》发表以来，5 岁以上镰状细胞病（SCD）儿童青霉素预防管理一直存在争议。在这项研究中，我们试图描述儿科血液学家目前与 5 岁以上 SCD 儿童停止青霉素预防的实践模式。
我们对儿科血液学专家进行了横断面电子调查，以检查 5 岁以上 SCD 儿童青霉素预防的实践情况。我们还使用 Jonckheere-Terpstra 检验和 Fisher 确切检验调查了与继续使用青霉素预防相关的潜在因素。
在 76 个中心的 106 名医生中，有 84%完成了调查。在回答者中，76%的人常规建议在 5 岁后停止使用青霉素预防。常规在 5 岁后继续使用青霉素预防的做法与对肺炎链球菌抗生素耐药性的担忧减少有关（P=0.01），与在轻度 SCD 基因型中使用预防性青霉素有关（镰状血红蛋白-C 病和镰状 β（+）地中海贫血，P<0.001），与在儿童期使用其他预防性评估（例如，无症状性中风的 MRI）的增加有关（P=0.05）。
大多数具有 SCD 专业知识的儿科血液学家建议在 5 岁后停止预防性使用青霉素。
