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• W1601134310 abstract "In their review of the management of infections in patients without a spleen, Davidson and Wall recommend co-amoxiclav 625 mg 8-hourly or cefuroxime 250 mg 12-hourly for standby treatment of early suspected post-splenectomy infection [1Davidson RN Wall RA Prevention and management of infections in patients without a spleen.Clin Microbiol Infect. 2001; 7: 657-660Abstract Full Text Full Text PDF PubMed Scopus (208) Google Scholar]. 1 do not believe that this is sufficient standby treatment for the early symptoms of an illness that may progress to overwhelming post-splenectomy infection (OPSI). My recommendation would be a starting dose of amoxicillin 3 g followed by 1 g 8-hourly. It is well known that the early symptoms and signs of OPSI may be very non-specific—often resembling a flu-like illness—and may coincide with already irreversible physiologic damage [2Styrt B Infection associated with asplenia: risks, mechanisms, and prevention.Am J Med. 1990; 88: 33N-42NPubMed Google Scholar]. However, prompt and potent antibiotic therapy may be life-saving and may prevent serious morbidity. Why give 500 mg of amoxicillin when 3 g is likely to be more effective and is also known to be well tolerated? While all would agree that prompt medical attention is crucial, delays in management do occur—particularly when people are traveling and/or on vacation. Given that OPSI still occurs despite immunization and/or prophylactic antibiotics [3Ejstrud P Kristensen B Hansen JB et al.Risk and patterns of bacteraemia after splenectomy: a population-based study.Scand J Infect Dis. 2000; 32: 521-525Crossref PubMed Scopus (109) Google Scholar, 4Foss Abrahamsen A Hoiby EA Hannisdal E et al.Systemic pneumococcal disease after staging splenectomy for Hodgkin's disease 1969–1980 without pneumococcal vaccine protection: a follow-up study 1994.Eur J Haematol. 1997; 58: 73-77Crossref PubMed Scopus (20) Google Scholar, 5Zarrabi MH Rosner F Rarity of failure of penicillin prophylaxis to prevent postsplenectomy sepsis.Arch Intern Med. 1986; 146: 1207-1208Crossref PubMed Scopus (23) Google Scholar, 6Sekikawa T Shatney CH Septic sequelae after splenectomy for trauma in adults.Am J Surg. 1983; 145: 667-673Abstract Full Text PDF PubMed Scopus (78) Google Scholar, 7Evans DI Fatal post-splenectomy sepsis despite prophylaxis with penicillin and pneumococcal vaccine.Lancet. 1984; 1: 1124Abstract PubMed Scopus (47) Google Scholar, 8Brivet F Herer B Frernaux A et al.Fatal post-splenectomy pneumococcal sepsis despite pneumococcal vaccine and penicillin prophylaxis.Lancet. 1984; 2: 356-357Abstract PubMed Scopus (43) Google Scholar], asplenic individuals must be given the best available advice for the management of febrile illnesses. An additional issue is the choice of co-amoxiclav itself. Given that Streptococcus pneumoniae accounts for around 90% of cases of OPSI [2Styrt B Infection associated with asplenia: risks, mechanisms, and prevention.Am J Med. 1990; 88: 33N-42NPubMed Google Scholar], there is little to be gained by the addition of clavulanate to amoxicillin. Although resistance to penicillins in S. pneumoniae is emerging, it is not mediated by βT-lactamases. Note from the Editor: Dr Davidson and Dr Wall did not choose to respond to this letter." @default.
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• W1601134310 date "2003-03-01" @default.
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• W1601134310 title "Stand-by treatment of sepsis in people without a spleen" @default.
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• W1601134310 doi "https://doi.org/10.1046/j.1469-0691.2003.00568.x" @default.
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