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Many kids with sickle cell disease don't get antibiotics

Updated:
CHICAGO (AP) _ Many children with sickle cell disease are not getting the antibiotics recommended for preventing life-threatening infections, a study suggests.

Sickle cell disease involves defective hemoglobin, the oxygen-carrying protein in red blood cells. The defect causes severe pain and makes patients prone to dangerous infections.

An estimated 2,000 U.S. children are born with sickle cell disease each year. The most common form is sickle cell anemia, which affects about 72,000 Americans, most of them black.

Daily penicillin is widely advised for children with sickle cell disease from infancy through age 5 to help keep them from getting pneumonia as well as bloodstream and brain infections.

But a study of Medicaid data in Tennessee and Washington found that children with sickle cell disease received only enough antibiotic prescriptions to last about five months of the year on average, and 10 percent received no antibiotics at all.

Insurance covered most of the patients' prescription costs, and the researchers said the reasons for the findings are unclear.

``Either doctors were not writing prescriptions ... or patients were not delivering prescriptions that were written to pharmacies,'' said Dr. Colin Sox of the University of Washington. ``It's probably a combination of both.''

The findings appear in Wednesday's Journal of the American Medical Association.

Sox and colleagues reviewed medical data on 261 children under 4. Information was collected from 1995 through 1999. Sox said similar results would probably be found in other regions of the country.

The findings suggest many children were left prone to what are known as pneumococcal infections, Sox said, though the researchers did not examine the incidence of those ailments.

Doctors and patients may not have been aware of the recommendations for daily antibiotics, which come from experts including the American Academy of Pediatrics, Sox said.

Also, insurance restrictions requiring patients to refill prescriptions monthly may have contributed, he said.

In addition, he noted that vaccines against pneumococcal disease became available toward the study's end and may have made some doctors think protective antibiotics were no longer necessary.

But available vaccines do not protect against all strains of the bacteria and the drugs are still recommended.

Dr. Leonard Valentino, a sickle cell expert at Chicago's Rush-Presbyterian-St. Luke's Medical Center, said some parents find it difficult to give their chronically ill children pills every day, or may not understand the need if their youngsters have never had a life-threatening infection.

``The controversy should really be zero'' because the benefits are ``pretty well-established,'' Valentino said.
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