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TUESDAY, Aug. 26, 2003 (HealthDayNews) -- Many small children with sickle cell anemia aren't getting the antibiotics they need to ward off potentially deadly infections.
That's the conclusion of a new study that appears in the Aug. 27 issue of the Journal of the American Medical Association.
People with sickle cell anemia have an abnormality that causes hemoglobin, the protein that carries oxygen, to change into sickle-like shapes that then clog blood vessels and obstruct blood flow. Children with the disease are at much higher risk of contracting Streptococcus pneumoniae infection, which can cause pneumonia and meningitis and lead to sepsis, or infection of the blood.
Sickle cell disease is hereditary and, in the United States, primarily strikes people of African descent, though it can also affect those of Mediterranean, Middle Eastern and East Indian origin.
A landmark study in 1986 showed that daily penicillin reduced the risk of infection by 84 percent. Since then, the American Academy of Pediatrics has recommended that all children with sickle cell disease receive daily doses of penicillin until at least the age of 5.
But the authors of the new study found that among two Medicaid populations, children were only getting the antibiotics for an average of 41 percent of the year.
The authors looked at 261 children with sickle cell disease in the states of Washington and Tennessee. More than 10 percent of the children received no penicillin at all. On average, the children received enough penicillin to cover 148.4 days. During the year, 64 percent of the children were hospitalized at least once. Because this study only looked at Medicaid recipients, it's not clear how people with private insurance are faring.
It's also not clear where the breakdown in getting the drugs to the children is occurring.
"There are several possibilities," says study author Dr. Colin M. Sox, a Robert Wood Johnson clinical scholar at the University of Washington in Seattle. "Either the doctors didn't write the prescriptions or the patients were not delivering the prescriptions that were written for them to the pharmacies. It may be a little bit of both."
It's also not clear why this is happening.
"It's possible that some physicians think that this medicine [penicillin] is no longer necessary," Sox says. A new, broader vaccine against pneumococcus bacteria -- Prevnar -- recently became available. Some doctors may think penicillin is no longer necessary if a child has been vaccinated, but this is just a guess, Sox says.
Dr. Stuart Toledano, director of pediatric hematology/oncology at the University of Miami School of Medicine, believes the problem more likely lies with parents.
"I would bet that 99 out of 100 hematologists are aware of this," says Toledano, who is a consultant to Children's Medical Services in Florida and is involved with all sickle cell programs in that state.
If a baby looks healthy, some parents are reluctant to administer medications. Also, doctors prefer that penicillin be given in pill form because pills have a longer shelf life than the liquid form and doesn't have to be refrigerated. But convincing a mother to crush up a pill rather than give liquid in a spoon can be a problem, Toledano says.
There's also the issue of convenience. Medicaid (and other insurance programs) will only give 30 days of medication at a time. This means that a mother, possibly with other children and a job, has to make endless trips to the pharmacy to refill the prescription.
Sox suggests that automatic refills or mail-order prescriptions could help reduce the burden on parents, as could having a member of a doctor's office staff devoted to following up on this issue.
"It's potentially a public health issue if you look at the early mortality of babies with sickle cell disease," Toledano says. "We see one to two kids a year with sickle cell who die of sepsis."
More information
For more on sickle cell anemia, visit Harvard University or the Sickle Cell Disease Association of America.
