Antibiotic prophylaxis regimens for patients with asplenia or hyposplenism

For prevention of infection with encapsulated bacteria (especially pneumococcus) in patients with asplenia or hyposplenism, useKanhutu 2017:

1amoxicillin 250 mg (child: 20 mg/kg up to 250 mg) orally, daily. See advice on duration of prophylaxis amoxicillin amoxicillin amoxicillin

1phenoxymethylpenicillin orally, 12-hourly; see advice on duration of prophylaxis phenoxymethylpenicillin phenoxymethylpenicillin phenoxymethylpenicillin

adult, or child 5 years or older: 250 mg

child younger than 1 year: 62.5 mg

child 1 to 5 years: 125 mg.

Penicillins are the drug of choice for antibiotic prophylaxis against pneumococcal infection; the use of other antibiotics is based on an extrapolation of available evidence. Penicillin resistance in Streptococcus pneumoniae is low and rates of resistance to alternative antibiotics are much higherAustralian Commission on Safety and Quality in Health Care (ACSQHC) 2021.

In patients reporting penicillin hypersensitivity, verify their allergy. In some patients it may be appropriate to directly delabel their allergy by taking an extensive allergy history (see Clinical history for initial assessment of patients reporting penicillin hypersensitivity); in these patients a penicillin may be given. Seek expert advice for patients with a verified allergy.

For patients who have had a nonsevere (immediate or delayed) hypersensitivity reaction to a penicillin, a suitable alternative that an infectious diseases physician or clinical microbiologist may recommend is:

cefuroxime 250 mg (child 3 months or older: 15 mg/kg up to 250 mg) orally, daily. See advice on duration of prophylaxis. cefuroxime cefuroxime cefuroxime

For patients who have had a severe immediate¹ hypersensitivity reaction to a penicillin, options that an infectious diseases physician or clinical microbiologist may use include:

performing desensitisation
using cefuroxime (see dosage above) – this can be considered if a beta-lactam antibiotic is strongly preferred (for considerations, see Severe immediate hypersensitivity: Implications of cross-reactivity between penicillins and cephalosporins)
using azithromycin (see dosage below).

For patients who have had a severe immediate¹ hypersensitivity reaction to a penicillin in whom cefuroxime or desensitisation is not used, or for patients who have had a severe delayed² hypersensitivity reaction to a penicillin, a suitable alternative that an infectious diseases physician or clinical microbiologist may recommend is:

azithromycin 250 mg (child: 5 mg/kg up to 250 mg) orally, daily³. See advice on duration of prophylaxis. azithromycin azithromycin azithromycin

For children in whom a suitable formulation of cefuroxime is not available, azithromycin may also be an appropriate alternative.

¹ Severe immediate hypersensitivity reactions include anaphylaxis, compromised airway, airway angioedema, hypotension and collapse.Return

² Severe delayed hypersensitivity reactions include cutaneous adverse drug reactions (eg drug rash with eosinophilia and systemic symptoms [DRESS], Stevens–Johnson syndrome/toxic epidermal necrolysis [SJS/TEN], severe blistering or desquamative rash), and significant internal organ involvement (eg acute interstitial nephritis).Return

³ Azithromycin is not available on the pharmaceutical benefits scheme (PBS) for this indication. If the cost is prohibitive, an alternative macrolide (eg roxithromycin) may be considered.Return