Dear Alice,

My sons are 16 and 18 and have Hereditary Spherocytocis, a disorder that makes the red blood cells spherical instead of "bialy" shaped like they should be. The condition is essentially cured by removing the spleen. They both have had their spleens removed and were prescribed prophylactic penicillin twice a day for an indefinite period of time. This is supposed to protect them in case they become infected with certain bacteria that can be a serious threat for a person without a spleen. With the latest information on the overuse of antibiotics and how it's affecting our health (e.g., healthy bacteria in the gut is killed, resistance builds to other antibiotics, etc.), I'm concerned about this. I've stopped giving them the penicillin daily. What is your understanding of this trade-off? Which is more harmful in the long run, not taking penicillin at all or taking it every day of their lives?

Thank you!

Dear Reader,

There are often difficult trade-offs associated with taking medicines, and you’re smart to educate yourself on this matter. Although there are risks involved in taking antibiotics long-term, it's generally recommended that individuals take antibiotics as prescribed, and to do their best to not miss any doses. Stopping treatment without finishing the recommended dosage may contribute to antibiotic resistance (more on this in a bit). Given your concerns, you may consider talking with your sons’ health care provider about the risks and benefits of taking antibiotics long-term. If you remain uneasy about the recommended course of treatment, another option is to seek opinions from other health care providers as well.

For those who are unfamiliar, spherocytosis is a genetic condition that causes red blood cells to be spherical instead of looking like flattened disks. The spleen removes the misshapen red blood cells from circulation and destroys them, which limits the movement of blood in a person’s blood vessels. As a result, the body doesn’t have enough red blood cells to function properly, which causes anemia. Spherocytosis may also lead to jaundice, a condition where a person’s eyes and skin turn a yellow hue, and splenomegaly, the enlargement of a person’s spleen. Spherocytosis is often remedied by a splenectomy, the surgical removal of an individual’s spleen. Recovery from a splenectomy typically lasts about two weeks, and, though it’s a safe procedure, people are at a higher risk of getting sick or infected right after the surgery takes place. Unfortunately, those who've had their spleen removed also have a life-long risk of developing infections, as the spleen plays a key role in helping the body fight off bacterial infection. 

Preventing infections with this condition relies on constant vigilance through education on risks and how to respond; immunizations as recommended by a health care provider; and antibiotics, which may be prescribed for a short time, for life, or for keeping on-hand in order to immediately respond to possible infections. Antibiotics are prescribed to fight off infection, whereas immunizations are typically recommended as additional precaution measures. Some people also choose to wear a medical bracelet to let others know that their spleen has been removed. Individuals without spleens are encouraged to contact their health care provider immediately in any of the following situations:

  • They develop a fever of 100.4 degrees Fahrenheit (38 degrees Celsius) or higher.
  • They notice red or tender spots on their body.
  • They have a sore throat, a cold that persists longer than expected, or chills that make them shiver or shake.

Adapted from Mayo Clinic.

While educating yourself and receiving recommended vaccines are undoubtedly helpful, taking antibiotics for an indefinite period of time has some risks involved. There’s some uncertainty on how effective antibiotics are when they're taken as preventative measures for a condition (rather than taken to treat an existing bacterial infection), and on how long they're intended to be taken. Risks of antibiotic use, misuse, and overuse range from allergic reactions (such as a rash) to antibiotic resistance. Antibiotic resistance occurs when bacteria no longer respond to an antibiotic. This usually happens when a spontaneous mutation occurs within the bacteria, often due to antibiotic misuse. This new strain helps the bacteria to survive.

Note that health care providers are aware of the pros and cons of taking antibiotics and are trained to prescribe antibiotics for the shortest amount of time deemed medically necessary for a given patient and condition. Experts stress how critical it is to take medications as prescribed, and not miss any doses, especially if a person has a condition that compromises their immune system. Because your sons have had their spleens removed, the risk of long-term infection may be higher, and their health care provider may have decided that this risk warrants prolonged antibiotic use.

There are a number of steps people can take to prevent antibiotic resistance:

  • Ask health care providers for recommendations on how to treat symptoms, rather than asking for an antibiotic right away.
  • Practice good hygiene (such as handwashing) to prevent bacterial infections that would require antibiotic treatment.
  • Avoid raw milk, wash your hands, and cook food to the recommended internal temperature to prevent foodborne bacterial infections.
  • Use antibiotics exactly as prescribed each day and finish the entire course of treatment.
  • Taking leftover antibiotics for a later illness or antibiotics prescribed for another person are examples of antibiotic misuse that are strongly discouraged.

Adapted from Mayo Clinic.

Reader, you ask which option is more harmful in the long run for your sons — taking antibiotics for an indefinite period of time or stopping them altogether — and unfortunately, there’s no easy answer. Only a health care provider can make the most informed recommendation based on your sons' specific medical histories. If you’re questioning your provider’s decision, you could try talking to them directly or getting a second opinion from another provider. Best of luck to you and your family!

Alice!

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