ASK DIS: 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

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:

ASK DIS