Antibiotic prophylaxis for patients with asplenia
| Routine prophylaxis* | |
| <3 y | PCN VK 125 mg twice daily (or amoxicillin 10 mg/kg by mouth twice daily) |
| ≥3 y | PCN VK 250 mg twice daily |
| Adults | PCN VK 250 mg by mouth twice daily (or amoxicillin 500 mg by mouth twice daily) |
| Adults with PCN allergy | Cephalexin 250 mg by mouth twice daily |
| Azithromycin 250 mg by mouth once daily | |
| Emergency antibiotics before ED arrival | |
| Child | Amoxicillin-clavulanate 45 mg/kg by mouth twice daily (maximum 875 mg per dose) |
| Child with PCN allergy | Cefdinir 7 mg/kg by mouth twice daily (max 300 mg per dose) |
| Levofloxacin 10 mg/kg by mouth twice daily (max 375 mg per dose) | |
| Adult | Amoxicillin-clavulanate 875 mg/125 mg by mouth twice daily |
| Adult with PCN allergy | Cefdinir 300 mg by mouth twice daily |
| Levofloxacin 750 mg by mouth once daily | |
| Moxifloxacin 400 mg by mouth once daily | |
| Preprocedural prophylaxis (for sinus surgery or airway procedure) | |
| Child | Amoxicillin 50 mg/kg 1 h before procedure (max 2 gram) |
| Adult | Amoxicillin 2 g 30-60 min before procedure |
| Routine prophylaxis* | |
| <3 y | PCN VK 125 mg twice daily (or amoxicillin 10 mg/kg by mouth twice daily) |
| ≥3 y | PCN VK 250 mg twice daily |
| Adults | PCN VK 250 mg by mouth twice daily (or amoxicillin 500 mg by mouth twice daily) |
| Adults with PCN allergy | Cephalexin 250 mg by mouth twice daily |
| Azithromycin 250 mg by mouth once daily | |
| Emergency antibiotics before ED arrival | |
| Child | Amoxicillin-clavulanate 45 mg/kg by mouth twice daily (maximum 875 mg per dose) |
| Child with PCN allergy | Cefdinir 7 mg/kg by mouth twice daily (max 300 mg per dose) |
| Levofloxacin 10 mg/kg by mouth twice daily (max 375 mg per dose) | |
| Adult | Amoxicillin-clavulanate 875 mg/125 mg by mouth twice daily |
| Adult with PCN allergy | Cefdinir 300 mg by mouth twice daily |
| Levofloxacin 750 mg by mouth once daily | |
| Moxifloxacin 400 mg by mouth once daily | |
| Preprocedural prophylaxis (for sinus surgery or airway procedure) | |
| Child | Amoxicillin 50 mg/kg 1 h before procedure (max 2 gram) |
| Adult | Amoxicillin 2 g 30-60 min before procedure |
ED, emergency department; PCN VK, penicillin V potassium.
Duration of routine prophylaxis depends on age, time since splenectomy, degree of immunocompromise, or prior episode of sepsis.