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Does every splenectomy need lifelong penicillin?

QShould all post-splenectomy patients be on lifelong penicillin, and isn't there the distinct possibility that organisms will simply develop penicillin resistance?

AFulminant life-threatening infection is a major

long-term risk in patients

with absent or dysfunctional spleen. Most serious infections are due to encapsulated bacteria; Streptococcus pneumonia is the most common but other organisms include Haemophilus influenzae-type b and Neisseria meningitidis.

These risks are higher in young children and those individuals with underlying immunosuppression. Risks are maximal in the early period following splenectomy, but persist for life.

Vaccination and antibiotic prophylaxis reduce these risks but do not necessarily eradicate them. Current recommendations are for all patients to receive appropriate vaccination and antibiotic prophylaxis with penicillin V (or erythromycin in sensitive patients).

This is particularly important for children and for those with underlying immunosuppression. There does not seem to be much evidence in the UK of the emergence of bacterial resistance with this approach.

Many patients, particularly adults, find compliance with daily antibiotics difficult. They should have a supply at home with instructions on when to take them.

Breakthrough infection may still occur and patients and their carers should be aware of this.

Dr Kate Ryan is a consultant haematologist at the Central Middlesex Hospital, London

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