Trying to improve compliance with prophylactic penicillin therapy in children with sickle cell disease

Abstract

Aims To evaluate compliance with prophylactic penicillin therapy in sickle cell disease (SCD) in children. Methods Forty-five children aged 37±19 (9-84) months [mean±s.d; range] with homozygous SCD were recruited. After a baseline period of 2 months the patients were randomized to either the intervention or non-intervention group. The intervention consisted of a slide show explaining the pathogenesis of sickle cell disease and its complications; weekly phone calls by the clinic social worker; and a calendar. Compliance was again evaluated after the 2 month intervention period and after a further 2 month monitoring period without intervention. Compliance was monitored using the Medication Event Monitoring System. At the end of the 6 months, parents in both groups completed a questionnaire the aims of which were to determine knowledge and understanding of sickle cell disease and previous experience with infection. Patient admissions to the hospital during the study were recorded. Results Compliance during the 2 month baseline assessment was 66.0±32.5 (1.3-98.2)% and 69. 3±25.4 (19.8-96.5)% in the intervention (n=13) and nonintervention (n=10) groups respectively ( P=0.79). During the next 2 months, compliance in the intervention group (n=11) was 79.0±31.4 (11.0-100.0)% and in the non-intervention group (n=9) was 66.0±20.2 (42.2-96.8)% ( P=0.297). In the final 2 month monitoring period compliance was 82.0±34.7 (3.8-100.0)% and 65. 8±25.3 (25.0-98.2)% in the intervention (n=7) and the non-intervention (n= 6) groups respectively ( P=0.366). No statistically significant differences were found when comparing compliance between the groups. Conclusions Compliance with prophylactic antibiotic therapy in children with sickle cell disease is highly variable and its evaluation is problematic.

Risk of Invasive Pneumococcal Disease in Children with Sickle Cell Disease in England: A National Observational Cohort Study, 2010–2015

“…More importantly, however, since PCV13-type IPD is now rare, our results therefore highlight the importance of education and advising on the importance of strict adherence to penicillin prophylaxis, which will help protect against all pneumococcal infections and against other encapsulated bacteria 29. The lack of penicillin resistance among pneumococcal isolates causing IPD in our cohort of children with SCD may suggest that these children were not adherent to penicillin prophylaxis at the time of infection.…”

Compliance with antibiotic prophylaxis in children with sickle cell anemia: a prospective study

“…O número de crianças incluídas nesta casuística (n = 108) foi superior ao da maioria dos estudos com objetivos semelhantes [14][15][16][17][18][19] . Todas elas provinham do PETN-MG e foram acompanhadas no HBH, o que possibilitou uma uniformidade da amostra.…”

Medication Adherence Among Pediatric Patients With Sickle Cell Disease: A Systematic Review

“…36 A randomized trial of parent education, regular social worker contact, and a medication calendar among 45 children was associated with a small but not statistically significant improvement in prophylactic antibiotic adherence. 50 Literature reviews indicate that, among pediatric patients, multicomponent interventions and those with a behavioral component are more likely to be effective than educational interventions alone. 51,52 Multicomponent interventions to improve adherence should target different barriers to adherence.…”