Determinants and Patterns of Antibiotic Use in Children with Sickle Cell Disease in Togo

Background: Recurrent bacterial infections in children with sickle cell disease (SCD) led to these children being given antibiotics (ATB) as a sort of systemic, broad-spectrum preventive antibiotic therapy. In addition to producing multidrug-resistant strains, this ATB pressure would also have a deleterious effect on the immune system. Investigating the frequency of antibiotic treatment and determining the major SCD-related factors that affect antibiotic use in sickle cell disease-affected children were our objectives. Methods: This retrospective and comparative study analyzed data from 465 children aged 0–15 years, collected between February and August 2022. The cohort included 255 children with sickle cell disease from the Centre National de Recherche et de Soins aux Drépanocytaires (CNRSD) and 210 without the disease from the Centre Hospitalier Universitaire Sylvanus Olympio (CHU SO), all aged between 0 and 15 years and all of whom had follow-up records at their respective centers between 2016 and 2022. Results: On a total of 465 children, 54.84 ± 4.52% (255:465) had sickle cell disease (Hb SS and Hb SC). The mean age of the study population was 6.36 ± 3.91 years with a mean weight of 19.25 ± 10.27 kg. Males were the most affected by SCD, with 51.76 ± 6.13%. On multivariate analysis, only symptoms such as osteoarticular pain (aOR = 51.375; p ≤ 0.001), anemia (aOR = 5.835; p = 0.002), and infectious syndrome (aOR = 4.537; p ≤ 0.001) were associated with sickle cell disease and were important clinical indicators of sickle cell disease progression. There was a significant difference in antibiotic prescribing, particularly in the aminoglycoside (p = 0.002), quinolone (p ≤ 0.001), and macrolide (p = 0.009) classes, between children with and without sickle cell disease. The frequency of prescription of ATBs according to class in SCD children was 44.71 ± 6.10%. Variability in the use of ATBs was more marked in SCD children than in non-SCD (2X and 3X) at almost identical percentages. Gentamicin was the antibiotic most frequently prescribed for SCD children. Among them, 19% received five or more ATBs in a year. Conclusion: SCD is very common in the children under investigation. Important clinical markers of the illness include infectious syndrome, anemia, and osteoarticular pain. With SCD children receiving much more prescriptions, management is primarily dependent on antibiotics, raising concerns about antimicrobial resistance and emphasizing the necessity for specialized treatment regimens.