Oral penicillin prophylaxis in children with imparied splenic function: a study of compliance.

One measure used to prevent overwhelming sepsis due to Streptococcus pneumoniae in children with defective splenic function is oral penicillin prophylaxis. However, a frequently cited argument against this approach is the likelihood of poor compliance. Compliance was studied by examining urine specimens for penicillin by the Sarcina lutea disc diffusion technique in 22 surgically asplenic children, two patients following bone marrow transplantation, and 38 infants and young children with sickle cell disease. Multiple specimens (mean 3.5 per patient) were examined in 43 of the children. Overall, 125/188 (66%) of the urine samples contained penicillin, indicating compliance within the previous 12 to 24 hours. Compliance tended to improve on subsequent clinic visits. These relatively good results were attributed to an intensive educational program in which repetitive efforts are made to counsel patients and parents about the risks of life-threatening infection. Poor compliance should no longer be invoked as a reason not to study the efficacy of prophylactic penicillin in functionally or surgically asplenic subjects.

Single-dose penicillin prophylaxis of neonatal group-B-streptococcal disease.

The efficacy of a single dose of aqueous penicillin G in preventing neonatal group-B streptococcal infections was demonstrated in a randomised study conducted over 41 months. 16 082 infant received a single dose of penicillin within one hour of delivery, and 15 976 infants who received tetracycline ophthalmic ointment served as the control group. Group-B streptococcal systemic infections were significantly less common in the penicillin-treated infants (0.6 vs 1.7 cases per 100 live birth, p = 0.004). The incidence of infection caused by penicillin-resistant pathogen was insignificantly increased in the penicillin group (2.2 vs 1.6 cases per thousand live birth, p = 0.32). this difference was accounted for almost completely by the events of the first 12 months of the study period when, for unexplained reasons, there was a considerable increase in the number of penicillin-resistant infections in the penicillin group (3.6 vs 1.4 cases per 1000 live births, p = 0.09). The mortality associated with penicillin-susceptible pathogens was higher in the control group (0.1 vs 0.4 per 1000 live births, p = 0.18). However, the mortality associated with penicillin-resistant pathogens was increased in the penicillin (0.4 vs 1.0 per 1000 live births, p = 0.06). The combined mortality rates for all pathogens were not significantly different (1.1 vs 0.7 per 1000 liver births, p = 0.27, for the penicillin and control groups, respectively) and were nearly equivalent when the excess number of deaths associated with penicillin-resistant infections in the penicillin group during the first study year was excluded from analysis. The incidence of gonococcal ophthalmia and conjunctivitis was unaffected by the use of intramuscular penicillin at birth.