Post Splenectomy Prophylaxis

When to Give

Elective Splenectomy 

• Vaccination should take place at least two weeks before the planned splenectomy. 
• Vaccination to be optimal if performed 4-6 weeks before the splenectomy but also advises that if the splenectomy needs to be performed more urgently it should not be deferred to allow this 4-6 weeks interval to be achieved  

Emergency/Unplanned Splenectomy 

• Vaccine is most effective if performed at least 14 days after surgery

Influenza Vaccination:

• An annual influenza vaccine of the appropriate type is recommended. 
• Some guidelines suggest giving influenza vaccine either pre-splenectomy (if planned) or after emergency splenectomy (or as soon as possible after a patient is identified as being hyposplenic).

Recommendations:

Antibiotic Prophylaxis

IM Benzathine Penicillin Prophylaxis

• based according to our Thalassaemia CPG, IM Benzathine Penicillin 3-4 weekly can be given as an alternative
• Although monthly administration of 1.2 MU of intramuscular benzathine penicillin is recommended as an alternative to oral penicillin V (cellulitis and rheumatic fever prophylaxis), based on management of asplenia patient, only oral antibiotics are recommended
• for those not tolerating orally, Benzylpenicillin (Penicillin G) 600mg iv bd (or clarithromycin 500mg iv bd if allergic to penicillin) can be given till patient is able to take oral antibiotics
• until the patient can take oral medication,

References:

1. http://www.surgicalcriticalcare.net/Guidelines/splenectomy_vaccines
2. http://www.racgp.org.au/download/documents/AFP/2010/June/201006jones
3. http://www.gloshospitals.nhs.uk/SharePoint1/Procedures%20and%20Guidelines/A0326
4. CPG Management of Transfusion Dependent Thalassaemia 2009