Guidelines for the Protection of the Adult Asplenic Patient
Antimicrobial prescribing: NHS Borders
Guidelines for the Protection of the Adult Asplenic Patient
Patients who have their spleen removed as a result of trauma or surgery should be considered for the following:
Vaccination Schedule
|
Elective splenectomy |
4-6 weeks pre-operatively
If this is not possible then up to 2 weeks before procedure |
|
Unplanned splenectomy |
At least 2 weeks post-operatively |
Vaccines
|
Meningococcal |
Meningococcal B vaccine and MenACWY conjugate vaccine
After 4 weeks give a second dose of the Meningococcal B vaccine |
|
Pneumococcal |
Pneumococcal polysaccharide vaccine PPV23. Repeat at 5 yearly intervals |
|
Influenza |
Recommended yearly for seasonal protection |
If immunisation unknown or for further information see the Green Book via https://www.gov.uk/government/collections/immunisation-against-infectious-disease-the-green-book
Prophylactic Antimicrobials
Antimicrobials should be given for at least two years post splenectomy and consideration given to lifelong prophylaxis
|
Phenoxymethylpenicillin (Pen V) 250mg twice daily
Penicillin allergy – Clarithromycin 250mg twice daily (unlicensed) or Erythromycin 500mg twice daily
|
Antimicrobial Treatment
In addition to prophylaxis, a supply of antimicrobials may be kept at home and used immediately should symptoms of raised temperature, malaise or shivering illness occur.
|
Co-amoxiclav (Amoxicillin/clavulanic acid) 625mg 8 hourly and seek medical advice Penicillin allergy Clarithromycin 500mg 12 hourly and seek medical advice |
Counselling
Patients should be given advice about general infection risk, foreign travel, further vaccines, food hygiene, malaria prophylaxis, animal and tick bites and the need for prompt referral to hospital if signs and symptoms of a febrile infection occur.
Patients should be given a patient information leaflet and a “no spleen” card for the patient to carry https://publichealthscotland.scot/publications/a-guide-for-people-without-a-working-spleen/
Ref. https://www.gov.uk/government/collections/immunisation-against-infectious-disease-the-green-book