Pediatric Splenomegaly Medication

Updated: Dec 30, 2020
  • Author: Trisha Simone Natanya Tavares, MD; Chief Editor: Vikramjit S Kanwar, MBBS, MBA, MRCP(UK), FAAP  more...
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Medication

Medication Summary

The choice of therapy depends on the specific etiology of the splenomegaly.

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Vaccines

Class Summary

Active immunization increases resistance to infection. Vaccines consist of microorganisms or cellular components, which act as antigens. Administration of the vaccine stimulates the production of antibodies with specific protective properties. Patients with decreased or absent splenic function are at increased risk for several vaccine-preventable infections.

Preferred sites for IM injection are 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 the gluteal area or areas with a major nerve trunk or blood vessel.

Minor illnesses (eg, mild upper respiratory tract infection with or without low-grade fever) are not generally contraindications.

If possible, administration of pneumococcal, meningococcal, and Hib vaccines should be performed at least 14 days prior to elective splenectomy. In the absence of preoperative vaccinations, inoculations should be given postprocedurally immediately after the patient’s condition stabilizes.

The CDC ACIP recommends that all children receive one of the conjugate vaccines licensed for use in infants beginning routinely at age 2 mo.

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 and account for 74% of penicillin-nonsusceptible S pneumoniae (PNSP) and 100% of pneumococci with high-level penicillin resistance.

Customary age for first dose is 2 mo, but can be administered as young as 6 wk. Preferred sites for IM injection are anterolateral aspect of thigh in infants or deltoid muscle of upper arm in toddlers and young children. Do not inject in gluteal area or areas with a major nerve trunk or blood vessel.

Number of 0.5-mL doses is 3 for infants aged 7-11 mo (4 wk apart; third dose after first birthday), 2 for those aged 12-23 mo (2 mo apart), and 1 for those aged 2-5 y.

Minor illnesses (eg, mild upper respiratory tract infection with or without low-grade fever) are not generally contraindications.

Pneumococcal vaccine polyvalent (Pneumovax-23)

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

Meningococcal vaccine (Menomune A/C/Y/W-135, Menactra)

Capsular polysaccharide antigens (groups A, C, Y, and W-135) of Neisseria meningitidis. 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 Centers for Disease Control and Prevention (CDC) guidelines.

Routine vaccination recommended for high-risk groups (eg, patients with deficiencies in late complement components [C3, C5-C-9], functional or actual asplenia, or laboratory or industrial exposure to N meningitidis aerosols; travelers or residents of hyperendemic areas).

Vaccine induces antibody response for serogroup A in individuals as young as 3 mo, but poorly immunogenic for serogroup C in recipients < 18-24 mo.

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

For routine immunization of children against invasive diseases caused by H influenzae type B by decreasing nasopharyngeal colonization. The CDC ACIP recommends that all children receive one of the conjugate vaccines licensed for use in infants beginning routinely at age 2 mo.

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Antibiotics

Class Summary

Daily antibiotic prophylaxis with penicillin is recommended to prevent pneumococcal septicemia in selected populations of anatomically or functionally asplenic children.

Penicillin VK (V-Cillin K, Veetids, Pen-Vee K)

Inhibits biosynthesis of cell-wall mucopeptide. Bactericidal against sensitive organisms when adequate concentrations reached. Most effective during stage of active multiplication. Low concentrations produce bacteriostatic effects.

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