Teach S J, Lillis K A, Grossi M
Department of Pediatrics, State University of New York at Buffalo School of Medicine, USA.
Arch Pediatr Adolesc Med. 1998 Mar;152(3):274-8. doi: 10.1001/archpedi.152.3.274.
To assess factors related to compliance with penicillin prophylaxis among patients with sickle cell disease.
Prospective case series.
Urban pediatric medical center where universal penicillin prophylaxis is recommended for all patients with any sickle cell hemoglobinopathy independent of age.
Eligible patients with sickle cell hemoglobinopathies were enrolled in either the emergency department or the sickle cell clinic.
Compliance was assessed by structured interview and by urine assay with an established method (Micrococcus luteus with disk diffusion) that detects excreted penicillin up to 15 hours after each dose administration.
Of the 159 patients actively followed up at the sickle cell center, 123 (77.3%) eligible patients were enrolled. Reported compliance by structured interview (> or = 1 dose of penicillin V potassium within 15 hours of enrollment) was 83 of 123 patients (67.5%; 95% confidence interval, 59.2%-75.8%), whereas measured compliance as determined by urine assay was 53 of 123 patients (43.1%; 95% confidence interval, 31.3%-51.7%). Measured compliance was significantly greater in patients younger than 5 years than in those older than 5 years (25/41 [61%] vs 28/82 [34%], respectively; P = .004), and was significantly greater in patients with private insurance than in those with public insurance (17/28 [61%] vs 33/90 [37%], respectively; P = .02). Measured compliance was not significantly associated with sex, site of recruitment, hemoglobinopathy, or chief complaint in the emergency department.
Measured compliance was poor, and patients and/or their families frequently misrepresented their compliance when interviewed. These data suggest that efforts are necessary to improve overall compliance, and they identify groups at greatest risk for noncompliance.
评估镰状细胞病患者中与青霉素预防性治疗依从性相关的因素。
前瞻性病例系列研究。
城市儿科医疗中心，该中心建议对所有患有任何镰状细胞血红蛋白病的患者，无论年龄大小，均进行青霉素预防性治疗。
符合条件的镰状细胞血红蛋白病患者在急诊科或镰状细胞病诊所登记入组。
通过结构化访谈和尿液检测评估依从性，尿液检测采用一种既定方法（用纸片扩散法检测藤黄微球菌），该方法可在每次给药后15小时内检测出排泄的青霉素。
在镰状细胞病中心积极随访的159例患者中，有123例（77.3%）符合条件的患者登记入组。通过结构化访谈报告的依从性（登记后15小时内服用≥1剂青霉素V钾）在123例患者中有83例（67.5%；95%置信区间，59.2%-75.8%），而通过尿液检测确定的实际依从性在123例患者中有53例（43.1%；95%置信区间，31.3%-51.7%）。5岁以下患者的实际依从性显著高于5岁以上患者（分别为25/41[61%]和28/82[34%]；P = 0.004），有私人保险的患者的实际依从性显著高于有公共保险的患者（分别为17/28[61%]和33/90[37%]；P = 0.02）。实际依从性与性别、招募地点、血红蛋白病或急诊科的主要诉求无显著关联。
实际依从性较差，患者和/或其家属在接受访谈时经常误报其依从性。这些数据表明有必要努力提高总体依从性，并确定依从性最差的高危人群。
