Under half of doctors know that antibiotic prophylaxis should be life long

EDITOR,—Despite several articles in the medical press over the past two years, including communications to all doctors from the chief medical officer, we were dismayed to note that several elderly patients admitted to our wards who had had splenectomies years previously had not been given advice on prophylaxis against infection or relevant immunisation. Deodhar et al found that in 184 patients who had had a splenectomy during a 12 year period 58% had not received advice or prophylaxis against infection and only 36% had received pneumococcal vaccination.1

We recently assessed doctors' knowledge of prophylaxis after splenectomy by means of a questionnaire survey. An anonymous questionnaire was sent to 160 hospital doctors of all grades and 200 general practitioners. A total of 118 questionnaires was returned for analysis (69 (43%) by the hospital doctors and 49 (25%) by the general practitioners). Most of the doctors (116/118) knew that patients who had had a splenectomy were at risk of pneumococcal infection. However, only half (34) of the hospital doctors and a third (16) of the general practitioners knew that patients were at risk of meningococcal infection and malaria. Most of the respondents (50 (72%) of the hospital doctors and 27 (55%) of the general practitioners) knew about the risk of Haemophilus influenzae infection. Although there was general awareness about antibiotic prophylaxis, only seven (14%) of the general practitioners and 34 (49%) of the hospital doctors knew that this prophylaxis should be life long.

Six of the general practitioners had a computerised splenectomy register, and 20 said that they would like more advice and information on managing patients who had had a splenectomy. The general practitioners had (to their knowledge) a total of 107 patients who had had a splenectomy registered with their practices; the commonest reasons for the operation were trauma, idiopathic thrombocytopenic purpura, and lymphoma.

Awareness and implementation of guidelines for preventing and treating infection in patients with reduced or absent splenic function is essential.2 This could be helped by the setting up of computer databases on patients. The guidelines in our district are accessible on the pathfinder system, which is a computerised information system available in our hospital and to a number of general practitioners. Hopefully, this system will become available to all general practitioners; the guidelines and other information would then be easily accessible.