Vital Antibiotics Overlooked for Children with Sickle Cell Anemia

Children with sickle cell disease often don't get the daily dose of antibiotics necessary to protect them from deadly infections.

A UW study found that pharmacies provided the children with a mean of 148 days a year of antibiotics, which cover roughly 41 percent of the year. Not taking daily antibiotics places these children at increased risk of serious illness and death. However, having more outpatient visits for preventive care is associated with improved provision of prophylactic antibiotics. Guidelines for sickle cell anemia care recommend that children younger than 5 years take daily medication to prevent pneumococcal infections, which can cause acute pneumonia in one or more lobes of the lung.

The study looked at the records of 261 children in Tennessee and Washington state who were documented to have sickle cell disease between 1995 and 1999, were 1 month to 48 months old when the study began, and were continuously enrolled in Medicaid while they were studied for 365 days. The mean age was 16 months. The researchers analyzed administrative claim and encounter data from TennCare, Tennessee's health insurance program for Medicaid enrollees and for uninsured or uninsurable individuals, and Washington State Medicaid from January 1995 to January 1999. TennCare is a managed care program, and Washington State Medicaid uses both fee-for-service and managed care plans.

The report was published in the Aug. 27, 2003, issue of the Journal of the American Medical Association. The lead author was Dr. Colin M. Sox, a pediatrician and a Robert Wood Johnson clinical scholar at the UW.

Sox got the idea for the study while a pediatric resident at the University of California, San Francisco, where he took care of children with sickle cell disease who were hospitalized with preventable infections.

Sickle-cell disease, also called sickle-cell anemia, primarily affects people of African descent, but also occurs in some people of Mediterranean, Middle Eastern, and East Indian origin. The disease is caused by genetic abnormalities that affect hemoglobin, the oxygen-carrying protein in red blood cells.

Dr. Colin Sox, led a study that concluded children with Sickle Cell Disease are not geting the recommended antibiotics.