Pediatric Asplenia Medication

The aim of medical therapy is to prevent invasive disease secondary to polysaccharide-encapsulated organisms, especially pneumococci. Penicillin and amoxicillin are currently the drugs of choice.

Class Summary

These agents are used to prevent invasive bacterial disease. Antibiotic prophylaxis is given to patients before they undergo procedures that may cause bacteremia.

Penicillin V (V-Cillin K, Veetids)

Bactericidal β -lactam antibacterial antibiotic. Main activity is against gram-positive organisms such as streptococci, some gram-negative organisms, and anaerobes. Approximately 60% of PO dose is absorbed. Best taken on empty stomach. Some prefer amoxicillin because it is more bioavailable and less expensive. Preferred for children < 2 y. PO susp (125 or 250 mg/mL) available.

Erythromycin base (EES, E-Mycin, Eryc)

Used for those with penicillin hypersensitivity. Limited activity against H influenzae. Bacteriostatic antibiotic that acts mainly by inhibiting protein synthesis. Administer >1-2 h pc. PO susp, chewable tab, and enteric-coated tab available.

Amoxicillin (Amoxil, Trimox)

Superior bioavailability and stability to gastric acid and has broader spectrum of activity than penicillin. Somewhat less active than that of penicillin against Streptococcus pneumococcus. Penicillin-resistant strains also resistant to amoxicillin, but higher doses may be effective. More effective against gram-negative organisms (eg, N meningitidis, H influenzae) than penicillin, thus, may provide better prophylaxis in children < 2 y.

Susp (125, 200, 250, or 400 mg/5 mL) and pediatric drops (50 mg/mL) available.

Class Summary

Active immunization increases resistance to infection. Vaccines consist of microorganisms or cellular components that act as antigens. The administration of the vaccine stimulates the production of antibodies with specific protective properties.

Because of the increased problem of penicillin resistance in S pneumoniae, prevention with PCV7/PCV13 in children or PPV23 in children and adults is mandatory. Similarly, immunizations with the conjugated H influenzae type b vaccine and the meningococcal conjugated or polysaccharide vaccine are essential.

Pneumococcal 7-valent conjugate vaccine (Prevnar)

Sterile solution of saccharides of capsular antigens of S pneumoniae serotypes 4, 6B, 9V, 14, 18C, 19F, and 23F individually conjugated to diphtheria CRM197 protein. These 7 serotypes responsible for >80% of invasive pneumococcal disease in children < 6 y in the United States. Accounts for 74% of penicillin-nonsusceptible S pneumoniae (PNSP) and 100% of pneumococci with high-level penicillin resistance. First dose recommended at age 2 mo but can be given in patient as young as 6 wk. Preferred sites of IM injection include the anterolateral aspect of the thigh in infants or the deltoid muscle of the upper arm in toddlers and young children. Do not inject in gluteal area or areas where a major nerve trunk or blood vessel may be present.

Three 0.5-mL doses for infants aged 7-11 mo (4 wk apart; third dose after first birthday), 2 doses for 12-23 mo (2 mo apart), 1 dose for >24 mo through 9 y. Minor illnesses such as a mild upper respiratory tract infection with or without low-grade fever are generally not contraindications.

Pneumococcal vaccine 13-valent (Prevnar 13)

Indicated for active immunization to prevent invasive disease caused by Streptococcus pneumoniae serotypes 1, 3, 4, 5, 6A, 6B, 7F, 9V, 14, 18C, 19A, 19F, and 23F. Also indicated for prevention of otitis media caused by S pneumoniae serotypes 4, 6B, 9V, 14, 18C, 19F, and 23F.

Pneumococcal vaccine polyvalent (Pneumovax-23, Pnu-Imune 23)

Polyvalent vaccine used for prophylaxis against infection with S pneumoniae. Used in populations with increased risk for pneumococcal pneumonia (eg, >55 y, chronic infection, asplenia, immunocompromise).

Haemophilus influenza type b vaccine (HibTITER, ActHIB, PedvaxHIB)

For routine immunization of children against invasive diseases caused by H influenzae type b. Decreases nasopharyngeal colonization. The CDC Advisory Committee on Immunization Practices (ACIP) recommends that all children routinely receive one of the conjugate vaccines licensed for use in infants beginning at age 2 mo.

Meningitis group A C Y and W-135 vaccine (Menomune)

Capsular polysaccharide antigens (groups A, C, Y, and W-135) of N meningitidis. Used for active immunization against invasive meningococcal disease caused by inclusive serogroups. May be used to prevent and control outbreaks of serogroup C meningococcal disease according to CDC guidelines. Routine vaccination is recommended for high-risk groups (eg, deficiencies in late complement components [C3, C5-C-9], functional or actual asplenia, laboratory or industrial exposure to N meningitidis aerosols, travelers or residents of hyperendemic areas). The vaccine induces antibody response for serogroup A in individuals as young as 3 mo, but it is poorly immunogenic for serogroup C in recipients who are younger than 18-24 mo.

For information concerning geographic areas in which vaccination is recommended, contact the CDC at (404)-332-4559.

Meningococcal conjugate vaccine (Menactra)

Capsular polysaccharide antigens (groups A, C, Y, and W-135) of N meningitidis individually conjugated to diphtheria toxoid proteins. Used for active immunization in individuals aged 2-55 years for the prevention of invasive meningococcal disease caused by inclusive serogroups. Routine vaccination also recommended for high-risk groups (eg, those with deficiencies in late complement components [C3, C5-C-9], functional or anatomic asplenia, properdin deficiencies, and travelers or residents of hyperendemic areas).

Influenza virus vaccine

Indicated for active immunization to prevent influenza a and b viruses. Induces antibodies following administration specific to virus strains contained in vaccine. Influenza vaccine contents are determined annually by the US Public Health Service. Typically, 3 live, attenuated virus strains are included in the formulation each year, which antigenically represent the influenza strains likely to circulate the next flu season.