In our experience with many sickle cell patients, either in acute crisis, acute chest syndrome, or even in bone marrow transplantation, the choice of antibioitics is dictated by the suspected organism. The hemolysis that has been reported or experienced by health providers could be better explained from the pain crisis or the acute event, rather than the antibiotics use. Ceftriaxone has been associated with cholestasis, and we saw one patient experienced this, but we have used ceftriaxone safely in others.

We still use ceftriaxone as our first line empiric therapy in children and adults with sickle cell disease and fever without a source as severe hemolysis is a very rare complication and can be seen with other cephalosporins as well. For acute cehst syndrome we generally use azithromycin and ceftriaxone combined for children and a extended spectrum fluroquinolone such as levofloxacin in adults. We consider additional gram positive coverage in those with central venous catheters and fever and then narrow our coverage based on culture results (if they are positive)

I think immunization status should also be an important consideration. You should assume that all patients with sickle cell are asplenic. So pneumococcus, meningococcus, GB strep, HIB many feature a little more prominently. WE have found that salmonella is also plays a greater role especially in osteomylelitis. E. coli infections (pyelonephritis, sepsis, meningitis) may also play an increased role in patients with sickle cell disease.

I agree with the necessity of antipneumococcus immunization. Here were Ceftrriaxone, wide spectrum antibiotic, labeled for treatment of severe Streptococcus pneumoniae infection particularly meningitis. we have a high rate of penicillin resistance of this bacteria and cannot challenge this risk in such patients.

Hospitalized children with Sickle Cell Disease presenting with pneumonia may be treated with azithromycin and ceftriaxone. Ceftriaxone is reported to cause cholestasis. However, adults may be administered with Fluroquinoline. In places where these antibiotics are not available, invasive pneumococcal infections in children with sickle cell disease may be prophylaxed and treated with penicillin. However, in cases of penicillin resistance, 23-valent pneumococcal polysaccharide vaccination should be administered.

We use 3 generation cephalosporin and we change after the cultures

12 to 13 % of pt with sickle cell anemia are likely to get severe immune hemolysis , hence should better be avoided

Thanks sir you answer is very convenient. Thanks

i think in this case the use of invanze or ertapenem ios acceptable to cover all gram negative and gram positive organism including esbl bacteria except pseudomonas

in addition it is once daily

I think ceftriaxone should work just fine for patients, but I'd like to ask on the safety experiences using chloramphenicol for treating salmonella infections

Third-generation cephalosporin esp. ceftriaxone usually doesn't cause hemolysis even though a theoretical risk does exist. We also add a macrolide.