Adesão à antibioticoterapia profilática em crianças com anemia falciforme: um estudo prospectivo

Abstract

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.

Understanding of technical education level professionals regarding sickle cell disease: a descriptive study

“…Some studies report that adherence to this treatment has been a challenge to health professionals (18)(19) .…”

Determinação dos níveis de malonaldeído e nitrito em indivíduos portadores de traço falciforme

“…18 Podemos verificar que o processo de miscigenação da população brasileira, modificou o padrão de expressão racial da hemoglobina S, uma vez que, essa pode ser encontrada nos diferentes grupos étnicos. 18 Os eritrócitos são particularmente susceptíveis a peroxidação lipídica devido à presença do ferro e do oxigênio nas hemácias, tornando a hemoglobina um potencial catalisador para a formação de EROs e para iniciação da reação de peroxidação lipídica. No presente estudo foi observado que não houve diferença estatisticamente significante para a dosagem MDA entre os grupos de traço falciforme e controle.…”

Antibiotic prophylaxis in sickle cell disease: a cross-section study of adherence and associated costs

“…Medical records were reviewed to obtain clinical data, and a semi-structured interview composed of eight questions adapted from Bitarães et al (2008) 14 was performed to assess adherence 15 . The interviews were carried out individually with the main caregivers at JFO.…”