Buchanan G R, Smith S J
Am J Dis Child. 1986 May;140(5):428-32. doi: 10.1001/archpedi.1986.02140190038020.
Although polyvalent pneumococcal vaccine and prophylactic penicillin are used to prevent overwhelming Streptococcus pneumoniae septicemia in infants and young children with sickle cell anemia, infection rates remain high. We have reviewed our seven-year experience with a regimen of twice daily oral penicillin V potassium prophylaxis in 88 affected children. The median age at the start of prophylaxis was 10 months, and the median duration of prophylaxis was 29 months (range, three months to seven years). The total period of observation of patients who were prescribed penicillin was 248 person-years. Most patients also received one or two doses of polyvalent pneumococcal vaccine. Despite penicillin prophylaxis and pneumococcal vaccine, eight episodes of S pneumoniae septicemia have occurred and three have been fatal. Four episodes were in children older than 3 years. Suboptimal compliance with the prescribed oral penicillin regimen was usually apparent. With one possible exception, the infections occurred when penicillin had not been taken during the previous 24 hours. The S pneumoniae septicemia rate in this patient population, 3.2 per 100 person-years, is somewhat less than that described in previous reports of children not receiving penicillin but is still unacceptably high. Vigorous advocacy of a penicillin prophylaxis regimen does not eliminate the risk of pneumococcal septicema in this patient population.
尽管使用多价肺炎球菌疫苗和预防性青霉素来预防镰状细胞贫血婴幼儿发生暴发性肺炎链球菌败血症，但感染率仍然很高。我们回顾了88例患病儿童采用每日两次口服青霉素V钾预防方案的7年经验。预防开始时的中位年龄为10个月，预防的中位持续时间为29个月（范围为3个月至7年）。接受青霉素治疗的患者的总观察期为248人年。大多数患者还接受了一剂或两剂多价肺炎球菌疫苗。尽管采用了青霉素预防和肺炎球菌疫苗，但仍发生了8例肺炎链球菌败血症，其中3例死亡。4例发生在3岁以上儿童。通常明显存在对规定口服青霉素方案的依从性欠佳情况。除一种可能的例外情况外，感染均发生在之前24小时内未服用青霉素时。该患者群体中肺炎链球菌败血症发生率为每100人年3.2例，略低于先前关于未接受青霉素治疗儿童的报告中所述的发生率，但仍然高得令人无法接受。大力倡导青霉素预防方案并不能消除该患者群体发生肺炎球菌败血症的风险。
