Tracking Antibiotic Prophylaxis Prescription in Children with Sickle Cell Disease

Key Takeaways

• Most children with sickle cell disease had a first penicillin prophylaxis prescription by 3 months.
• Rural residence was associated with later receipt of the first prescription.
• Sex, genotype, and birth year were not significantly associated with timing.

Among children with sickle cell disease born in Georgia, 81.8% had a first penicillin prophylaxis prescription by 3 months, while rural residence was associated with later receipt of the first prescription, according to a new publication in JAMA Pediatrics.

Researchers analyzed Georgia newborn screening data linked with State Electronic Notifiable Disease Surveillance System records to assess prescription timing from birth through 12 months. Investigators identified 1,951 children with sickle cell disease born between 2008 and 2022. They excluded 238 children because geographic data were insufficient, leaving 1,713 children in the analytic cohort. Urbanicity was assigned from maternal addresses using Rural-Urban Commuting Area codes, and the Cox model included urbanicity, sex, genotype, and birth year.

By 2 months, 63.1% of children, or 1,081 of 1,713, had received a first penicillin prophylaxis prescription. That cumulative proportion rose to 81.8%, or 1,401 children, by 3 months and 98.9%, or 1,694 children, by 12 months. Rural residence was associated with a lower hazard of receiving prophylaxis by 3 months, with a hazard ratio of 0.82, a 95% CI of 0.70 to 0.95, and P = .01. Restricted mean survival time analysis estimated a 4.34-day later prescription in rural areas, with a 95% CI of 0.57 to 8.11 and P = .02; the clinical impact of this difference is unclear. Sex, genotype, and birth year were not statistically significant in the model.

The authors concluded that the overall prescribing pattern suggests Georgia's newborn screening program is facilitating preventive care delivery, though a substantial proportion of infants did not initiate prophylaxis by the guideline-recommended age of 2 months. They noted that the rural difference may reflect barriers to access to sickle cell specialty care. Limitations included possible SENDSS data-entry error, unmeasured socioeconomic confounding, and exclusion of children not captured or with missing or incomplete records. The analysis focused on timing of the first prescription rather than longer-term follow-up after prescribing, and did not assess medication initiation or adherence after prescription.