Indications for antibiotic prophylaxis for patients with asplenia or hyposplenism
Antibiotic prophylaxis to reduce the risk of invasive infection with encapsulated bacteria (especially pneumococcus) is an important consideration in the management of patients with asplenia and hyposplenism. Although there is evidence to support prophylaxis for children with sickle cell disease, the role of prophylaxis for other patients with asplenia or hyposplenism is less clearDi Sabatino 2011Rankine-Mullings 2017Rubin 2014. Antibiotic prophylaxis is intended to prevent pneumococcal infection; however, the regimens in this topic also prevent Haemophilus influenzae type b (Hib) and Neisseria meningitidis infection.
Seek expert advice on the management of antibiotic prophylaxis for patients with asplenia or hyposplenism.
Before starting prophylaxis, explain the harms and benefits of antibiotic prophylaxis so the patient or carer can make an informed decision about using prophylaxis. For general information about adverse effects associated with antimicrobial use, see Types of adverse effects of antimicrobials.
Antibiotic prophylaxis is usually indicated forKanhutu 2017:
- children 5 years or younger with asplenia or hyposplenism
- patients who have had a splenectomy – prophylaxis is started as soon as oral therapy is tolerated postoperatively.
Also consider prophylaxis for patients with asplenia or hyposplenism who are at higher risk of invasive pneumococcal infection. Factors associated with a higher risk of invasive pneumococcal infection include:
- incomplete vaccination against pneumococcal disease
- primary immunodeficiency disorder
- HIV infection
- haematological malignancy
- immunosuppressive therapy
- previous invasive pneumococcal disease.