Fever Management in Sickle Cell Disease in Low- and Middle-Income Countries: A Survey of SCD Management Programs.

Management of fever is a key element of care for children with sickle cell disease (SCD). There exist few studies of current practices in managing fevers in SCD in low- and middle-income countries (LMICs) and malaria-endemic regions where SCD is prevalent. We surveyed medical providers in these settings to characterize current practices in infection prevention and fever management for children with SCD. We found wide variation in use of newborn screening for early diagnosis and infection prevention, pneumococcal vaccination, use of antibiotics and antimalarials, and route of antibiotic administration. Counter to established guidelines, 78% (95% CI: 59-100%) of respondents would consider using oral antibiotics for a febrile child with SCD. Only 17% (95% CI: 0-37%) would administer antibiotics to a well-appearing child with a positive malaria test. Availability of blood cultures did not affect duration of antibiotic course. Further study and standardization of fever management in SCD in LMICs are urgently needed.