Long term management after splenectomy: A national problem

BMJ 1994; 308 doi: https://doi.org/10.1136/bmj.308.6924.338a (Published 29 January 1994) Cite this as: BMJ 1994;308:338
  1. J N Barnes,
  2. H A Deodhar,
  3. R J Marshall
  1. Royal Cornwall Hospital, Truro, Cornwall TR1 3LJ.

    EDITOR, - We wish to respond to the correspondence on our paper on the increased risk of sepsis after splenectomy.1 We were saddened by Helena M Daly's letter.2 We did not set out to audit individual clinicians but to identify why asplenic patients are still admitted to hospital and die with overwhelming pneomococcal sepsis. Since we submitted our data a further patient who had not received prophylaxis has died in Cornwall of pneumococcal sepsis. The data from Paul Kinnersley and colleagues3 and Sheena Reilly and colleagues4 confirm that this is a national problem. Our statement that we do not know what advice - if any - they had been given clearly referred to the six patients who died of pneumococcal sepsis. None of these patients were under Daly's care.

    The initiative taken by Peter Baddeley and colleagues4 is welcome. Reilly and colleagues,4 R P D Cooke and colleagues,4 Peter J Flegg,4 and M Makris and colleagues4 all highlight important issues. In particular, Makris and colleagues draw attention to the uncertainty surrounding the use of prophylactic antibiotics. We acknowledged this in our paper but have elected to use prophylactic antibiotics until evidence from trials indicates that we should not. We think that the approach adopted by Makris and colleagues is equally valid. Our own policy, therefore, is to offer patients vaccination against pneumococcal, meningococcal, and Haemophilus influenzae infections. We believe that children should receive continuing antibiotic prophylaxis with penicillin, erythromycin, or amoxycillin, while adults should receive the same for at least two years postoperatively. Selected immonocompromised groups of adults should also continue antibiotics for the rest of their lives. Educating patients about the risks that they face is the most important issue of all, and patients should have antibiotics at home to take in the event of infection.

    We reiterate the need to establish protocols that clearly identify responsibilities for ensuring that all patients receive appropriate management. All patients already at risk who have not yet been identified need to be actively sought.


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