PREVENTION OF SERIOUS BACTERIAL-INFECTION IN CHILDREN WITH NEPHROTIC SYNDROME

Although nephrotic syndrome is well known as a predisposing factor to bacterial infection in children, especially peritonitis due to Strepto coccus pneumoniae, data on the incidence of infection and the effectiv eness of preventative measures are limited. With particular reference to pneumococcal disease, this review summarises the available data on the pattern and incidence of invasive bacterial infection in children with nephrotic syndrome, and the level of evidence for the use of peni cillin chemoprophylaxis and pneumococcal immunisation. Although data o n the effectiveness of pneumococcal immunisation in children with neph rotic syndrome are limited, the safety profile of this vaccine makes t he risk-benefit ratio favourable to use of the current polysaccharide vaccine in those over 2 years of age. Conjugate pneumococcal vaccines are likely to be more effective, particularly in children under 2 year s of age and should be available by the year 2000. Although penicillin prophylaxis against pneumococcal infection is not of proven benefit f or nephrotic syndrome, it is beneficial in sickle cell disease without appreciable risk. Subgroups of patients with nephrotic sydrome most l ikely to benefit from twice daily phenoxymethyl penicillin prophylaxis include children under 2 years of age, with unresponsive or frequentl y relapsing disease, or who have had a previous episode of pneumococca l infection.