Estudo da adesão à antibioticoterapia profilática em crianças portadoras de doença falciforme: estudo prospectivo no Hemocentro de Belo Horizonte (2005-2006)

Abstract

Compliance with prophylactic antibiotic, mainly penicillin, was studied in 108 children with sickle cell anemia who were followed-up for 15 months at a Hematology Center in Belo Horizonte, Brazil. Compliance was assessed through three interviews and reports from medical records; antibiotic intake was checked in 81 children through its antibacterial activity in a single sample of urine. The urine was collected by mothers at home dipping it on a filter paper strip, inserted into glassine envelope and then into a prepaid reply envelope that was mailed to the researchers. Prescribed antibiotic was free of charge for all patients. The oral route has been chosen by parents of 78% of children; the other had 21-day intramuscular penicillin, exclusively or alternating with the oral route. There were 45% boys and 55% girls; the median age was 25.3 months. Childrens mother was responsible for the administration of antibiotic in the majority of families. 56% of urines tested positive for the antibiotic; 48% of caregivers assured that all doses had been given during the interviews. No doses were missed in 89% of cases according to medical files. If a child was considered compliant when none or justone of these three methods detected missing doses, the rate of compliance was 67%. The agreement between methods on assigning a child as compliant or not was low. About ten percent of caregivers said that they had some difficulty in getting the child to take the medicine. When caregivers were asked about understanding doctors advices, most answers were based on their knowledge of the disease itself rather than the importance of prophylactic antibiotic. Only 9 caregivers had some educational approach from the nursing staff. No significant association of compliance rate with the gender, nutritional status, family per capitaincome, education levels of the caregivers, or number of family members was demonstrated. Compliance is a complex subject that cannot be understood only in terms of indirect or direct measurement of adhesion rates to medical prescription. The behavior of patients and their families towards the prescribed regimens, their beliefs and knowledge about their disease, their daily life, and the designated role of health professionals, patients and families in the whole process of health and disease should be taken into due account. The results of the present study suggestthe need for a comprehensive educational program for health professional staff and for the families and children with sickle cell anemia.