Duration of antibiotic prophylaxis for patients with asplenia or hyposplenism

The optimal duration of prophylaxis for adults and children with asplenia or hyposplenism remains controversial. Duration of prophylaxis should be based on risk factors for invasive pneumococcal infection, as well as drug tolerability and the likelihood of adherence.

Give antibiotic prophylaxis:

• up until the age of 5 years in children with asplenia, or hyposplenism due to sickle cell disease or other congenital haemoglobinopathy
• for at least 3 years after splenectomy.

Consider lifelong prophylaxis for patients who:

• have survived overwhelming postsplenectomy infection, particularly invasive pneumococcal infection
• are significantly immunocompromised (eg those with coexisting hypogammaglobulinaemia or advanced liver disease, solid organ transplant recipients)
• have had a splenectomy for haematological malignancy, particularly those with graft-versus-host disease (GVHD) or receiving immunosuppressive therapy.