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The Pediatric Forum |

Adherence to Prophylactic Antibiotic Guidelines Among Medicaid Infants With Sickle Cell Disease

Michael D. Warren, MD, MPH; Patrick G. Arbogast, PhD; Judy A. Dudley, BS; Lisa Kaltenbach, MS; Wayne A. Ray, PhD; Winfred C. Wang, MD; William O. Cooper, MD, MPH
Arch Pediatr Adolesc Med. 2010;164(3):298-299. doi:10.1001/archpediatrics.2009.286.
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Infants with sickle cell disease have as much as a 100-fold increased rate of pneumococcal infection compared with the general population.1 Penicillin prophylaxis has been shown to reduce the risk of pneumococcal sepsis by 84%.2 Thus, sickle cell management guidelines include twice daily penicillin doses for infants and young children.3 While studies have described low rates of adherence to prophylactic antibiotic guidelines in older children, little is known about the initiation of prophylactic antibiotics in early infancy, a period of great vulnerability.4 We describe adherence to guidelines for initiation of prophylactic antibiotics in a cohort of Medicaid infants with sickle cell disease in Tennessee and examine risk factors for nonadherence.

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Association of multiple risk factors with nonadherence to prophylactic antibiotic guidelines among a cohort of Tennessean Medicaid infants with sickle cell disease born from 1997 to 2006. Risk factors include having a single mother, maternal age younger than 20 years, maternal education of less than 12 years, familial income in the lowest quintile, and urban residence. Error bars indicate 95% confidence intervals; *P = .02.

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