Penicillin Prophylaxis in the Vaccination Era: Physician Perspectives on Its Role in Sickle Cell Disease

BACKGROUND: Penicillin prophylaxis is a long-established strategy for preventing invasive pneumococcal disease (IPD) in children with sickle cell disease (SCD). However, its continued necessity in the era of widespread pneumococcal vaccination remains uncertain, particularly in highly immunized populations. AIMS AND OBJECTIVES: This study aimed to evaluate current prescribing patterns, perceived barriers, and physician attitudes toward penicillin prophylaxis in pediatric SCD care in Saudi Arabia, where vaccination coverage is high. MATERIALS AND METHODS: A national cross-sectional survey was conducted among physicians managing children with SCD. The questionnaire assessed routine practices regarding penicillin prophylaxis, age of discontinuation, perceived adherence barriers, and openness to revising guidelines or participating in further research. RESULTS: Fifty physicians responded to the survey. Of these, 94% reported routinely prescribing penicillin to young children with SCD. While 56% discontinued prophylaxis at five years of age, 44% continued beyond that point due to concerns about vaccine failure, insufficient regional data, or outdated guidelines. Notably, more than half had not encountered a culture-confirmed pneumococcal infection in the past five years; reported cases occurred primarily in unvaccinated or non-adherent patients. Major challenges identified included suboptimal adherence, limited drug availability, and concerns about long-term antibiotic use. A majority of respondents (78%) favored revisiting existing prophylaxis guidelines, and many supported additional research, including surveillance studies (86%) and clinical trials (68%). CONCLUSION: Despite reduced IPD incidence, penicillin prophylaxis remains widely used beyond the age of five in clinical practice across Saudi Arabia. These findings highlight the need to update national guidelines to reflect contemporary vaccination impact and clinical realities. There is strong physician support for evidence-based, risk-adapted prophylaxis strategies that align with local epidemiology and evolving standards of care.