From the Research
The recommended approach for treating acute chest syndrome (ACS) in sickle cell disease (SCD) patients is to start with a third-generation cephalosporin such as ceftriaxone (2g IV daily for adults; 50-75 mg/kg/day for children) plus a macrolide like azithromycin (500mg IV/PO daily for adults; 10mg/kg/day for children) to cover typical and atypical pathogens. This approach is supported by the most recent and highest quality study available, which found that the combination of ceftriaxone and azithromycin was associated with the shortest length of stay and a reduced risk of ACS-related readmission 1.
Key Considerations
- The use of antibiotics is essential in treating ACS, even when infection is not confirmed, as it can rapidly worsen respiratory status in SCD patients and trigger further sickling 2, 3.
- The choice of antibiotics should be guided by the most recent and highest quality evidence available, which currently supports the use of ceftriaxone and azithromycin as the first-line treatment 1.
- Supportive care with oxygen, hydration, and pain management should accompany antibiotic therapy to ensure the best possible outcomes for patients with ACS.
Alternative Treatment Options
- For patients with severe illness or penicillin allergy, vancomycin (15-20mg/kg IV q12h for adults; 10-15mg/kg IV q6h for children) plus a respiratory fluoroquinolone such as levofloxacin (750mg IV/PO daily for adults; 8-10mg/kg/day for children) may be used as an alternative treatment option.
- However, the evidence for these alternative treatments is limited, and more research is needed to establish their effectiveness in managing ACS in SCD patients 4, 5.
Duration of Treatment
- Treatment should continue for 7-10 days, with transition to oral antibiotics when the patient shows clinical improvement.
- The use of procalcitonin-guided therapy may help reduce antibiotic exposure and improve outcomes in patients with ACS, but more research is needed to confirm its effectiveness 3.