Bibliographic information
GuidelineWHO consolidated guidelines for the management of common childhood illness: management of sickle-cell disease in children and adolescents
Year of Publication2026
Issuing InstitutionWorld Health Organization
Recommendation
New
In children aged less than 5 years with sickle-cell disease (SCD), prophylactic penicillin (oral or intramuscular (IM)) is suggested to prevent pneumococcal infection, including in those who have received age-appropriate pneumococcal vaccination.
Recommended in favor
Conditional
Certainty of evidence
Low
Notes and Remarks
- Children with SCD aged less than 5 years are at increased risk of invasive pneumococcal disease. Prophylactic penicillin is recommended regardless of pneumococcal immunization status.
- Health care providers should engage families in shared decision-making regarding the choice between oral and IM penicillin, taking into account lifestyle, preferences and feasibility.
- For oral administration, dispersible tablets or liquid formulations are preferred to facilitate ease of use in young children.
- Adherence to oral prophylaxis may be suboptimal due to the need for daily administration and lack of provider oversight. IM administration ensures compliance but may be less acceptable to some families due to discomfort or logistic challenges.
- In children with a documented allergy to penicillin, erythromycin may be used as an alternative