COMPLIANCE WITH PENICILLIN PROPHYLAXIS IN PATIENTS WITH SICKLE-CELL DISEASE

Objective: To assess factors related to compliance with penicillin pro phylaxis among patients with sickle cell disease. Design: Prospective case series. Setting: Urban pediatric medical center where universal p enicillin prophylaxis is recommended for all patients with any sickle cell hemoglobinopathy independent of age. Participants: Eligible patie nts with sickle cell hemoglobinopathies were enrolled in either the em ergency department or the sickle cell clinic. Main Outcome Measures: C ompliance was assessed by structured interview and by urine assay with an established method (Micrococcus luteus with disk diffusion) that d etects excreted penicillin up to 15 hours after each dose administrati on. Results: Of the 159 patients actively followed up at the sickle ce ll center, 123 (77.3%) eligible patients were enrolled. Reported compl iance by structured interview (greater than or equal to 1 dose of peni cillin V potassium within 15 hours of enrollment) was 83 of 123 patien ts (67.5%; 95% confidence interval, 59.2%-75.8%), whereas measured com pliance as determined by urine assay was 53 of 123 patients (43.1%; 95 % confidence interval, 31.3%-51.7%). Measured compliance was significa ntly greater in patients younger than 5 years than in those older than 5 years (25/41 [61%] vs 28/82 [34%], respectively; P=.004), and was s ignificantly greater in patients with private insurance than in those with public insurance (17/28 [61%] vs 33/90 [37%], respectively; P=.02 ). Measured compliance was not significantly associated with sex, site of recruitment, hemoglobinopathy, or chief complaint in the emergency department. Conclusions: Measured compliance was poor, and patients a nd/or their families frequently misrepresented their compliance when i nterviewed. These data suggest that efforts are necessary to improve o verall compliance, and they identify groups at greatest risk for nonco mpliance.