ResumoObjetivo: Avaliar a adesão a antibiótico profilático em crianças com anemia falciforme.Métodos: Estudo prospectivo de 108 crianças (idade entre 3 meses e 4,5 anos, 45% masculino) seguidas por 15 meses no Hemocentro de Belo Horizonte. Avaliou-se a adesão por meio de três entrevistas com cuidadores, análise de prontuário médico e atividade antibacteriana em uma amostra de urina em 81 crianças. Os antibióticos foram dispensados gratuitamente.Resultados: Penicilina foi usada em 106 casos (maioria via oral), e eritromicina, dois casos. O antibiótico foi detectado na urina de 56% das crianças; 48% dos cuidadores afirmaram nas entrevistas que nenhuma dose deixou de ser administrada; em 89% dos prontuários médicos, não se registrou falha de adesão. Considerando-se aderente a criança que não apresentasse falhas em nenhum ou em apenas um dos métodos, a taxa de adesão foi de 67%. O grau de concordância entre os três métodos para medir a adesão foi baixo. Não se demonstrou qualquer associação entre a taxa de adesão e o gênero, estado nutricional, renda familiar per capita, nível educacional dos cuidadores ou número de membros da família. Conclusões:A taxa de adesão à antibioticoterapia profilática foi baixa quando avaliada por meio de questionários e testes urinários, e superestimada quando avaliada pela consulta ao prontuário médico. A adesão deve ser preferencialmente avaliada por vários métodos, pois sua mensuração é complexa. Os resultados do presente estudo sugerem a necessidade de programas educacionais abrangentes para os profissionais de saúde, para as famílias e crianças portadoras de anemia falciforme. J Pediatr (Rio J). 2008;84(4):316-322:Anemia falciforme, antibioticoprofilaxia, recusa do paciente ao tratamento, fidelidade a diretrizes, penicilina V. AbstractObjective: To prospectively assess compliance with antibiotic prophylaxis among children with sickle cell anemia. Methods:A total of 108 children (aged 3 months to 4½ years, 45% male) were recruited from the Hematology Center in Belo Horizonte, Brazil, and followed up for 15 months. Data on compliance were obtained from three interviews with the primary caregivers, from the children's medical records and from assay of antibacterial activity in urine samples of 81 children. Antibiotics were available free of charge.Results: Penicillin was used in 106 cases (majority by oral route); erythromycin in 2 cases. Urine samples tested positive for the antibiotic in 56% of the cases; 48% of the caregivers assured during interviews that all doses had been administered to children; 89% of medical files recorded no compliance failures. Considering a child compliant if none or just one of these methods detected missing doses, the rate of compliance was 67%. The agreement between methods for assigning a child as compliant or not was low. No significant association of compliance rate with gender, nutritional status, per capita income of the family, caregivers' schooling, or number of family members was demonstrated. Conclusions:Compliance rate with prophylactic antibi...

Objective: To prospectively assess compliance with antibiotic prophylaxis among children with sickle cell anemia.Methods: A total of 108 children (aged 3 months to 4½ years, 45% male) were recruited from the Hematology Center in Belo Horizonte, Brazil, and followed up for 15 months. Data on compliance were obtained from three interviews with the primary caregivers, from the children's medical records and from assay of antibacterial activity in urine samples of 81 children. Antibiotics were available free of charge.Results: Penicillin was used in 106 cases (majority by oral route); erythromycin in 2 cases. Urine samples tested positive for the antibiotic in 56% of the cases; 48% of the caregivers assured during interviews that all doses had been administered to children; 89% of medical files recorded no compliance failures. Considering a child compliant if none or just one of these methods detected missing doses, the rate of compliance was 67%. The agreement between methods for assigning a child as compliant or not was low. No significant association of compliance rate with gender, nutritional status, per capita income of the family, caregivers' schooling, or number of family members was demonstrated. Conclusions:Compliance rate with prophylactic antibiotic therapy was low when assessed by interviews and urine tests and overestimated by analysis of medical records. Compliance should preferably be assessed by several methods due to the complex character of its measurement. The results of the present study suggest the need for a comprehensive educational program involving healthcare professionals, families and children with sickle cell anemia.J Pediatr (Rio J). 2008;84(4):316-322: Sickle cell anemia, antibiotic prophylaxis, treatment refusal, guideline adherence, penicillin V.