Background: Children with sickle cell anaemia (SCA) are highly susceptible to infection caused by pneumococcal bacteria due to functional asplenia amongst other reasons. Pneumococcal infections are severe with high mortality among these children that the need for prophylactic penicillin therapy becomes necessary. The objective of this review is to look for evidence of the effectiveness of daily oral penicillin prophylaxis in the prevention of pneumococcal infection in children with SCA.
Methods: Electronic databases including genetic disorders group haemoglobinopathies trial register, Cochrane library, Pubmed, Turning Research Into Practice (TRIP) and Google were searched for relevant studies. Hand and grey literature searches were also done. Randomized controlled trials comparing oral penicillin prophylaxis for the prevention of pneumococcal infection in children with SCA with placebo or no treatment were searched for.
Results: Two trials were found to have met the inclusion criteria for the review. Results of the two included randomized controlled trials showed a significant reduction in the incidence of pneumococcal infection among children with SCA (and (0)-thallasaemia) receiving penicillin compared to the control group treated with placebo. The odds ratios for the two (Gaston et al and Falletta et al) studies were 0.37 (95% CI 0.16 to 0.86) and 0.5 (95% CI 0.1 to 2.71) respectively.
Conclusion: There is strong evidence that daily oral penicillin prophylaxis greatly reduces the risk of pneumococcal infection in children with SCA under the age of three years and a moderately strong evidence that its, withdrawal at the age of five years did not result in any serious consequences.