{"id":62,"date":"2023-05-09T21:58:49","date_gmt":"2023-05-09T20:58:49","guid":{"rendered":"https:\/\/microregistrar.com\/?p=62"},"modified":"2023-05-14T16:04:19","modified_gmt":"2023-05-14T15:04:19","slug":"what-prophylaxis-is-recommended-in-splenectomy-patients","status":"publish","type":"post","link":"https:\/\/microregistrar.com\/?p=62","title":{"rendered":"What prophylaxis is recommended in splenectomy patients?"},"content":{"rendered":"\n<p>Patients with an absent or dysfunctional spleen (AoDS) are at increased risk of infection, especially with capsulated bacteria.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">What are the organisms that can cause infection in patients with AoDS?<\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Streptococcus pneumoniae (commonest)<\/li>\n\n\n\n<li>Neisseria meningitidis<\/li>\n\n\n\n<li>Haemophilus influenzae type B<\/li>\n\n\n\n<li>Capnocytophaga canimorsus<\/li>\n\n\n\n<li>Bordetella holmesii<\/li>\n\n\n\n<li>Babesia microti<\/li>\n\n\n\n<li>Plasmodium falciparum<\/li>\n\n\n\n<li>Salmonella (in cases of sickle cell anaemia)<\/li>\n\n\n\n<li>Anaplasma may present with recurrent\/prolonged and severe infection in AoDS<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\">Prevention of infection \u2013 vaccines, antibiotic prophylaxis<\/h2>\n\n\n\n<h4 class=\"wp-block-heading\">Antibiotic<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Antibiotic prophylaxis reduces incidents of sepsis (in children) by up to 50% and mortality by up to 90%.<\/li>\n\n\n\n<li>However, Prophylactic antibiotics are not absolute protection against infection. Vaccines should be given in conjunction.<\/li>\n\n\n\n<li>Lifelong prophylaxis is recommended.<\/li>\n<\/ul>\n\n\n\n<p class=\"has-cyan-bluish-gray-background-color has-background\"><strong>What is the risk of sepsis?<\/strong><br>The risk of death from sepsis is 600 times more than the general population; the estimated lifetime risk of sepsis is 5%. [Lynch 1996]<br><br><strong>When is the risk of infection highest?<\/strong><br>&#8211; children up to 16 years of age,<br>&#8211; adults over 50 years of age and<br>&#8211; for two years post-splenectomy.<br><br><strong>Who must be considered for lifelong prophylaxis?<\/strong><br>&#8211; Those who have had invasive pneumococcal disease,<br>&#8211; those treated for splenic malignancy<br>&#8211; those who have received splenic irradiation or<br>&#8211; Those who have ongoing graft versus host disease.<br><br><strong>Who can be considered for discontinuation of prophylaxis?<\/strong><br>&#8211; Splenectomy following trauma can be considered for stopping prophylaxis if appropriately counselled.<br>&#8211; Children over 5 years of age with sickle cell disease &#8211; can be considered for stopping antibiotic if they have received pneumococcal vaccination and does not have a history of severe pneumococcal disease. Patients\u2019 consultants should be consulted\/expert opinions taken.<\/p>\n\n\n\n<h5 class=\"wp-block-heading\">What are the preferred antibiotics?<\/h5>\n\n\n\n<p><strong>Phenoxymethylpenicillin PO<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>&lt; 1 year: 62.5mg BD<\/li>\n\n\n\n<li>1 \u2013 5 years: 125 mg BD<\/li>\n\n\n\n<li>&gt;5 years: 250mg BD<\/li>\n<\/ul>\n\n\n\n<p><strong>Amoxicillin PO (additional cover for H influenzae in children)<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>1 mo \u2013 5 years: 125mg twice daily<\/li>\n\n\n\n<li>5 \u2013 12 years: 250mg twice daily<\/li>\n\n\n\n<li>12 \u2013 18 years: 500mg twice daily<\/li>\n<\/ul>\n\n\n\n<p><strong>Erythromycin PO<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>1 mo \u2013 2 years: 125mg twice daily<\/li>\n\n\n\n<li>2 \u2013 8 years: 250mg twice daily<\/li>\n\n\n\n<li>&gt; 8 years: 500mg twice daily<\/li>\n<\/ul>\n\n\n\n<p>Other antibiotics that have been used \u2013 Azithromycin, cefalexin<\/p>\n\n\n\n<p>An emergency rescue pack of antibiotics can be used if regular prophylaxis is not possible \u2013 Coamoxiclav, levofloxacin etc.<\/p>\n\n\n\n<h4 class=\"wp-block-heading\">Vaccine<\/h4>\n\n\n\n<h5 class=\"wp-block-heading\" id=\"h.5l0s6a5q0cfw_l\">When should we give the vaccine?<\/h5>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Elective splenectomy: vaccine should be given two weeks before splenectomy.<\/li>\n\n\n\n<li>Emergency splenectomy: vaccine should be given two weeks after splenectomy.<\/li>\n<\/ul>\n\n\n\n<h5 class=\"wp-block-heading\">What vaccine should we give?<\/h5>\n\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"1024\" height=\"579\" src=\"https:\/\/microregistrar.com\/wp-content\/uploads\/2023\/05\/Screenshot-2023-05-09-212803-1024x579.jpg\" alt=\"Vaccination in splenectomy\" class=\"wp-image-63\" srcset=\"https:\/\/microregistrar.com\/wp-content\/uploads\/2023\/05\/Screenshot-2023-05-09-212803-1024x579.jpg 1024w, https:\/\/microregistrar.com\/wp-content\/uploads\/2023\/05\/Screenshot-2023-05-09-212803-300x170.jpg 300w, https:\/\/microregistrar.com\/wp-content\/uploads\/2023\/05\/Screenshot-2023-05-09-212803-768x435.jpg 768w, https:\/\/microregistrar.com\/wp-content\/uploads\/2023\/05\/Screenshot-2023-05-09-212803-320x180.jpg 320w, https:\/\/microregistrar.com\/wp-content\/uploads\/2023\/05\/Screenshot-2023-05-09-212803.jpg 1285w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\" \/><\/figure>\n\n\n\n<p><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Patients with an absent or dysfunctional spleen (AoDS) are at increased risk of infection, especially with capsulated bacteria. What are [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":97,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ngg_post_thumbnail":0,"footnotes":""},"categories":[10,11],"tags":[15,18,16,17],"class_list":["post-62","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-prophylaxis","category-vaccine","tag-asplenia","tag-prophylaxis","tag-splenectomy","tag-vaccine"],"_links":{"self":[{"href":"https:\/\/microregistrar.com\/index.php?rest_route=\/wp\/v2\/posts\/62","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/microregistrar.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/microregistrar.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/microregistrar.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/microregistrar.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=62"}],"version-history":[{"count":1,"href":"https:\/\/microregistrar.com\/index.php?rest_route=\/wp\/v2\/posts\/62\/revisions"}],"predecessor-version":[{"id":64,"href":"https:\/\/microregistrar.com\/index.php?rest_route=\/wp\/v2\/posts\/62\/revisions\/64"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/microregistrar.com\/index.php?rest_route=\/wp\/v2\/media\/97"}],"wp:attachment":[{"href":"https:\/\/microregistrar.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=62"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/microregistrar.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=62"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/microregistrar.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=62"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}