Guidelines for the Protection of the Adult Asplenic Patient

Antimicrobial prescribing: NHS Borders
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