Prophylactic antibiotics, vaccinations in sickle cell

Study population
We identified children with SCA using a case definition that included at least three
SCA-related claims for a kid in a calendar year (282.61, 282.62). When compared to
the gold standard of newborn screening data, this case definition has been shown to
have a high level of sensitivity (91.4%) and specificity (80%). 17,18 Within this time
frame, continuous enrollment in the Medicaid program for at least one calendar year
was necessary. To maximize the completeness of claims available for each year a
child was eligible for the study population, we limited our analysis to children who
had no other forms of health insurance (ie, private insurance) during the study
period.

Definition:
The NHLBI recommends oral penicillin as a prophylactic against IPD. For children
with a suspected or proven penicillin allergy, the American Academy of Pediatrics
advises erythromycin, although amoxicillin is frequently recommended for practical
reasons and is similarly effective against S pneumoniae. As a result, we used the
following four definitions to classify antibiotics:
1. oral penicillin;
2. oral penicillin or erythromycin;
3. oral penicillin, erythromycin, or amoxicillin; and
4. any antibiotic likely to protect against S pneumoniae (including penicillin,
erythromycin, amoxicillin)

Antibiotics were identified in pharmacy claims by using relevant national drug codes
associated with an antibiotic. An author with expertise in pediatric infectious diseases
(A.T.) reviewed these records and classified them as described above.
Adakveo is an injectable drugs that includes crizanlizumab, a monoclonal antibodies.
Crizanlizumab binds to P-selectin on vascular endothelial surfaces and platelets,
blocking interactions between endothelial cells, platelets, erythrocytes, and
leukocytes, resulting in reduced aggregation and critical vascular shutdown.
Clinical efficacy: Adakveo was approved by the FDA based on the results of a
randomized clinical trial that included 198 patients with sickle cell disease and a
history of 2 to 10 critical vascular events in the 12 months prior to trial entry. clinical.
Patients were randomly assigned to receive crizanlizumab 5 mg/kg (n = 67),
crizanlizumab 2.5 mg/kg (n = 66) or placebo (n = 65) as a strong intravenous
infusion over 30 minutes at week 0 , week 2, and then every 4 weeks. The total
duration of treatment was 52 weeks.

Background:
Children with sickle cell anemia (SCA) are at increased risk for invasive
pneumococcal disease; antibiotic prophylaxis significantly reduces this risk. We
calculated the proportion of children with SCA who received ≥300 days of antibiotic
prophylaxis and identified predictors of such receipt.

Methods:
In Florida, Illinois, Louisiana, Michigan, South Carolina, and Texas, children aged 3
months to 5 years with SCA were identified by the existence of three or more
Medicaid claims with a diagnosis of SCA within a calendar year (2005–2012).
Antibiotic receipt was discovered through claims for filled prescriptions. The
outcome, receiving 300 days of antibiotics, was evaluated on an annual basis using
different antibiotic classifications. We calculated the probabilities of obtaining 300
days of antibiotics using logistic regression with generalized estimating equations,
using age, sex, year, state, and health-care utilization as potential factors.
Results
From 2005 to 2012, the MAX data set revealed a total of 2821 children with SCA,
ranging in age from 3 months to 5 years, providing a total of 5014 person-years.
Florida (1619, 32%), Texas (897, 18%), Louisiana (855, 17%), Illinois (622, 12%),
Michigan (580, 12%), and South Carolina (580, 12%) were the states with the
highest number of person-years (441, 9 percent ). There were 48 percent females (n
= 1364) and 52 percent boys (n = 1457) in the study population. The average age in
2005 was 1.6 years (SD = 1.1), which remained steady throughout the study. With
the exception of South Carolina, where the median age was one year, the median
age across states was two years.
Reference

National Heart, Lung, and Blood Institute

. Evidence-based management of sickle cell disease. 2014. Available
at: https://catalog.nhlbi.nih.gov/sites/default/files/publicationfiles/56-364NFULL.pdf. Accessed November 11, 2014

Critchley IA, Brown SD, Traczewski MM, Tillotson GS, Janjic N. National and regional assessment of antimicrobial

resistance among community-acquired respiratory tract pathogens identified in a 2005-2006 U.S. Faropenem
surveillance study. Antimicrob Agents Chemother. 2007;51(12):4382–4389

Jacobs MR, Good CE, Windau AR, et al. Activity of ceftaroline against recent emerging serotypes of Streptococcus

pneumoniae in the United States. Antimicrob Agents Chemother. 2010;54(6):2716–2719