ADHERENCE TO THE USE OF PROPHYLATIC PENICILLIN AND ASSOCIATED COSTS IN SICKLE CELL DISEASE

Abstract

Background: Sickle cell disease (SCD) is the most prevalent hemoglobinopathy in the world with a lethality of 3.4%. The main cause of death in this population is related to infectious conditions. Infection control in children with SCD depends on early diagnosis, an extended vaccination card and regular prophylactic use of penicillin, however, the low rate of adherence to antibiotic prophylaxis is a common problem in clinics. Aim: to assess the adherence to antibiotic prophylaxis and to describe the cost of prophylactic antibiotics in children with SCD. Methods: Cross-sectional study of 126 children born between 1998 and 2007 with SCD. Adherence was assessed through structured interviews with caregivers, review of medical records and the data were correlated with the socioeconomic profile of the main caregiver. To measure costs the dosage and periodicity of the drugs followed the Clinical Protocol and Therapeutic Guidelines for SCD. The price of phenoxymethylpenicillin was extracted from the Price Bank of the Regulation Chamber of the Medicines Market. Results: Of the 115 patients included, 50.4% were male. The analysis of the questionnaire revealed that the mother was the main responsible for the answers (83.5%) and the main caregiver who administered the medication (86.1%). Maximum adherence, defined as no absence of administration and regular hours, was 45.2%. The family income of 37.4% of respondents was less than the minimum wage. There was no statistically significant association between the adherence rate and the variables: gender, family income and education of caregivers. The total real cost of the sample with phenoxymethylpenicillin was US $ 102,824.50. Considering only those who had maximum membership (45.2%) this amount was US $ 47,922.65. Conclusions: Adherence to prophylactic antibiotic therapy was low and actions are needed to increase the use of penicillin, which is not a high-cost medication. Financial support: Fundação de Amparo à Pesquisa do Estado de Minas Gerais (FAPEMIG) APQ-01513-10, Fundação Hemominas and National Institute of Health. Number ID Grant HHSN26822011000071 (REDSIII).